| What is the definition of Adherence | extent to which patient behaviour coincides with medical advice |
| Difference between compliance and adherence | Compliance is the extent to which patient conforms or fulfills medical advice while adherence is the extent to which patient behavior coincides with medical advice
Compliance is the passive behavoir of following a list of instructions from the doctor
Adherence is more positive and proactive behavoir resulting in lifestyle change by the patient |
| What can poor adherence lead to | Worsening of disease
Death
Increased health care cost |
| What are some strategies to improve adherence | Raising information and skill levels
Simplification of medication regimens
Long-term reinforcement
Education
Development of dispensing aids
Improved communication between the patient and health care provider |
| What are some direct ways of measuring adherence | Urine/blood test - most direct measure, but is expensive , invasive and can be effected by metabolism
Observation of consumption |
| What are some indirect ways of measuring adherence | Pill counts - unreliable due to lost pills
Self-report - Easy to obtain, inexpensive, but may have issues with accuracy, bias etc.
Second-hand reports (doctors, carers etc.)
Electronic measures of dose which record the times at which bottles are opened
Repeat prescription records |
| What are some unintentional nonadherence reasons | Lack of understanding of instructions
Forgetting instructions/doses
Difficulty following and integrating regime into daily life
Problems accessing treatment |
| What are some intentional nonadherence reasons | Beliefs
Attitudes and expectations of patients
Personal choices |
| Five types of non-adherence | Consistent Underdoser --> Regularly neglects to take one of the prescribed doses, such as the midday dose Regularly takes only some of the prescribed medications
Consistent Overdoser --> Regularly takes a drug more often or in larger doses than is prescribed
Random doser --> Takes the medications when she or he thinks of it
Abrupt Overdoser --> Does not take medications properly and then takes an overdose prior to a clinic visit Doubles up for missed doses
Tourist --> Abruptly stops all medications for a few days or weeks Takes one day off per week |
