Health Psychology on Compliance & Adherence

Questions and Answers

What is the definition of compliance in the context of health psychology?

The ability of a doctor to treat patients effectively

The degree to which patients understand their medical conditions

The agreement reached between patient and doctor

The extent to which the patient follows medical advice (correct)

What is non-adherence most commonly associated with in the context of chronic illness?

Lower medication costs

Complete recovery from illness

Increased hospital admissions (correct)

Higher patient satisfaction rates

Which disease type has been associated with the highest rates of adherence?

Respiratory diseases

Diabetes

Hypertension

HIV disease (correct)

What was the average rate of non-adherence found in DiMatteo's review of studies?

24.8% Signup and view all the answers

Which of the following statements is true regarding the concept of adherence?

Adherence reflects a more collaborative relationship between patients and doctors Signup and view all the answers

What percentage of adult renal transplant patients were found to be non-adherent to their medications, according to Greenstein & Siegel (1998)?

22% Signup and view all the answers

What is one advantage of recording the time a container is opened?

It accurately measures if a dose has been dispensed. Signup and view all the answers

What is a disadvantage of using urine or blood tests for measuring adherence?

They may be affected by metabolism. Signup and view all the answers

According to Ley's cognitive hypothesis model, what influences compliance most directly?

Understanding of medical advice. Signup and view all the answers

What percentage of hospital patients were reported to be dissatisfied with treatment according to Ley (1988)?

41% Signup and view all the answers

What factor is influenced by anxiety and may affect patient recall after a consultation?

Memory Signup and view all the answers

What is an implication of Ley's model for improving patient compliance?

Emphasize repetitive communication of instructions. Signup and view all the answers

Which of the following is a common misconception that may hinder patient understanding?

Patients frequently have misconceptions about treatment and anatomy. Signup and view all the answers

What can be a criticism of Ley’s model in terms of patient information?

It fails to consider the role of information to correct deficits. Signup and view all the answers

What aspect of health may improving adherence interventions affect more than medical treatment improvements?

Overall health of the population Signup and view all the answers

Which of the following is NOT a problem with measuring adherence?

Availability of medication Signup and view all the answers

What is a disadvantage of patient self-reporting regarding adherence?

Prone to inaccuracies and bias Signup and view all the answers

According to Ley (1988), what was the correlation between doctors' ratings of patient adherence and other measures?

0.21 Signup and view all the answers

Which of the following provides a more objective measure of adherence, but may still be inaccurate due to lost pills?

Pill counts Signup and view all the answers

How accurate are the patient adherence rates reported by Ley (1988) compared to more objective measures?

78% versus 46% Signup and view all the answers

What is a key limitation of mechanical or electronic measures of medication adherence?

Dependence on consistent medication use Signup and view all the answers

Which factor does NOT affect preparation for treatment adherence?

Immediate character of treatment Signup and view all the answers

What financial implication is associated with non-adherence?

Higher healthcare expenditures Signup and view all the answers

What is a consequence of treatment that can hinder adherence?

Medication side effects Signup and view all the answers

Which factor increases patient adherence according to doctor-patient interaction?

Warm and caring interaction Signup and view all the answers

According to the Health Belief Model, what increases the likelihood of medication adherence?

Beliefs aligning with treatment Signup and view all the answers

Which of the following is a factor that does NOT influence patients' beliefs about risks and benefits of medication?

Physician's perception Signup and view all the answers

What aspect of administration of treatment can negatively impact adherence?

Failure of parents to supervise Signup and view all the answers

Which belief about illness is relevant for treatment adherence?

Perception of illness as chronic Signup and view all the answers

What is an example of a barrier to following treatment?

High cost of medications Signup and view all the answers

What is one key aspect to promote patient trust and satisfaction with care?

Discuss treatment options transparently. Signup and view all the answers

What should be done to ensure the patient understands their treatment options?

Provide information in their preferred format. Signup and view all the answers

What is important to ascertain about a patient's attitude towards decision making?

Their preferred role in decision making. Signup and view all the answers

What should be considered when reviewing patient decisions?

Patient's needs and preferences after sufficient consideration. Signup and view all the answers

What tension exists in the concordance approach to prescribing?

The balance between patient preference and physician authority. Signup and view all the answers

Which factor does not typically affect patient adherence?

Clinical trials conducted in other countries. Signup and view all the answers

What should a clinician do if a patient requires more time to consider options?

Defer and allow time for consideration. Signup and view all the answers

Which element is critical for effective communication between doctor and patient?

Encouraging open dialogue. Signup and view all the answers

Study Notes

Compliance, Adherence, and Concordance

Compliance refers to the extent a patient follows medical advice, emphasizing a doctor-centered approach where the patient is passive.
Adherence focuses on the alignment between patient behavior and medical recommendations, promoting a patient-centered model with mutual agreement.

Extent of Non-Adherence

Non-adherence is common, especially among chronic illness patients, with estimates of 30-50% non-adherence rates.
Approximately 10-25% of hospital admissions are due to non-adherence.
Review of 733 studies over 50 years reveals an average non-adherence rate of 24.8%.
Lifestyle changes often show particularly low adherence rates.

Disease-Specific Non-Adherence

Severe diseases, including organ transplant recipients, show significant non-adherence, with 22% of renal transplant patients failing to take immunosuppressants.
Non-adherence leads to higher rates of organ rejection or death.
HIV, arthritis, GI disorders, and cancer show the highest adherence rates; pulmonary disease, diabetes, and sleep disorders have the lowest.

Impact of Non-Adherence

Non-adherence negatively affects patient health and incurs financial costs.
Enhancing adherence interventions may yield greater health benefits than improvements in medical treatments.

Measuring Adherence

Treatment typically involves ongoing adherence, making measurement challenging.
Variability in adherence measures complicates comparisons across different studies and conditions.

Indirect Measures of Adherence

Patient self-reporting is easy and inexpensive but often inaccurate, with reported compliance at 78%, contrasted with objective measures around 46%.
Second-hand reports from healthcare providers reflect similar issues.
Pill counts provide a more objective measure but can still be inaccurate due to lost pills.
Mechanical or electronic dosage reminders can measure dispensing but not actual consumption.

Direct Measures of Adherence

Biological tests (urine or blood) offer direct adherence measures but are invasive, costly, and affected by metabolic factors.
Observational methods mimic the challenges present in biological measures.

Barriers to Adherence

Common barriers include high treatment costs, lack of information, and potential side effects.
Patient satisfaction during consultations strongly correlates with adherence rates.

Ley’s Cognitive Hypothesis Model

Patients' understanding, memory, and satisfaction impact compliance.
Satisfaction derives from emotional support, perceived competence, and correctness of diagnosis.

Patient Understanding and Recall

Many patients struggle with recalling medical information accurately—only a fraction can define illnesses or remember treatment specifics.
Recall is influenced by anxiety, prior knowledge, and modality of information presented.

Improving Compliance

Effective communication is essential, involving simplified information, repetition, and clear written instructions.
Follow-up consultations help reinforce understanding and adherence.

Criticisms of Ley’s Model

Limits of information correction and treatment preparation highlight the need for a broader view of adherence factors.

Treatment Factors & Adherence

Poor supervision, continuity of care, and treatment characteristics (complexity, inconvenience, expense) can hinder adherence.

Doctor-Patient Interaction

Warm, caring physician behaviors improve patient adherence.
Interpersonal and technical competence, as well as positive body language, increase patient compliance.

Health Belief Model

Cognitive model explains adherence based on patients' beliefs about disease and treatment benefits.
Adherence depends on perceived disease severity, susceptibility, treatment benefits, and barriers.

Patients’ Beliefs

Patient understanding of illness severity and medication risks influences adherence levels.
Positive patient relationships with healthcare providers facilitate trust and adherence.

Steps Towards Concordance in Prescribing

Clarifying problems by integrating patient input, conveying treatment options, and ensuring understanding fosters concordance.
Encourage patient feedback on care decisions to tailor treatments to individual needs.

Concordance Tensions

Navigating the balance between evidence-based medicine and patient autonomy is crucial for fostering adherence.
Addressing potential conflicts between patient rights and responsibilities enhances concordance.

Summary Points

Key factors affecting adherence include memory, understanding, satisfaction, doctor-patient communication, and social context.
Barriers can stem from treatment complexity, perceived stigma, or socio-economic factors that influence adherence levels.

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Description

This quiz explores the concepts of compliance, adherence, and concordance in the context of health psychology and human diversity. Engage with questions that highlight the dynamics of patient-doctor relationships and the importance of following medical advice. Test your understanding of these crucial psychological principles in healthcare.