{"id":269,"date":"2021-03-04T16:44:04","date_gmt":"2021-03-04T16:44:04","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/?post_type=chapter&#038;p=269"},"modified":"2021-03-04T16:44:04","modified_gmt":"2021-03-04T16:44:04","slug":"adherence-to-medical-advice","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/chapter\/adherence-to-medical-advice\/","title":{"raw":"Adherence to Medical Advice","rendered":"Adherence to Medical Advice"},"content":{"raw":"<header class=\"entry-header\">\r\n<h1 class=\"entry-title\">Types of Non-adherence and reasons why patients do not\u00a0adhere<\/h1>\r\n<\/header>\r\n<div class=\"entry-content\">\r\n<p>Medical Adherence: the extent to which patients take medications as prescribed by\u00a0 health care providers.<\/p>\r\n\r\n<ul>\r\n \t<li>Up to 40% of the population fail to adhere to medical advice.<\/li>\r\n \t<li>125,000 people die every year due to failure to comply.<\/li>\r\n<\/ul>\r\n<p><strong>Types and extent of non-adherence<\/strong><\/p>\r\n<p>Clarke (2013)\u00a0noted there are four types of adherence, which were turned into non-adherence types:<\/p>\r\n\r\n<ol>\r\n \t<li>Not following short-term advice<\/li>\r\n \t<li>Failing to attend a follow-up interview \/\/ referral appointment<\/li>\r\n \t<li>Refusing to make a life-style change.<\/li>\r\n \t<li>Failing to take preventative health measures.<\/li>\r\n<\/ol>\r\n<p><strong>Rational non-adherence<\/strong><\/p>\r\n<p>Some patients do not adhere to medical advice after making a rational judgement, and find that there are more costs\/risks than benefits of the treatment.<\/p>\r\n<p>Lada, brien and Jan (2012)\u00a0studied a community of sample patients in Australia and measured the importance of\u00a0<strong>8 medication factors<\/strong>\u00a0through an online survey. The factors were put in order of the most important (1) to least important (8):<\/p>\r\n\r\n<ol>\r\n \t<li>Immediate medication harm<\/li>\r\n \t<li>Immediate medication benefit<\/li>\r\n \t<li>Long-term medication harm<\/li>\r\n \t<li>Long-term medication benefit<\/li>\r\n \t<li>Cost of treatment<\/li>\r\n \t<li>Regimen of treatment<\/li>\r\n \t<li>Symptom severity<\/li>\r\n \t<li>Alcohol restrictions<\/li>\r\n<\/ol>\r\n<div id=\"sf-inline-ad-0\" class=\"ata-frame-wrapper\"><\/div>\r\n<div id=\"inline-ad-0__controls\" class=\"ata-controls\"><\/div>\r\n<p>It was concluded that adherence was affected by the way the treatment was sold to patients. E.g. using words like \u2018therapeutic benefits\u2019 rather than \u2018side effects\u2019 would increase compliance.<\/p>\r\n<p>BULPITT AND FLETCHER (1988)\u00a0found out that when the costs of taking medication outweigh the benefits of treating the problem, mainly asymptomatic ones, patients are less likely to adhere.<\/p>\r\n<p>It was discovered that the main side effects of medication for hypertension were:<\/p>\r\n\r\n<ul>\r\n \t<li>Sleepiness<\/li>\r\n \t<li>Laziness<\/li>\r\n \t<li>Impotence<\/li>\r\n \t<li>Weakened cognitive functioning.<\/li>\r\n<\/ul>\r\n<p>For more detailed information \u2013\u00a0<a href=\"https:\/\/alevelpsychologycie.wordpress.com\/2018\/01\/05\/bulpitt-and-fletcher-1988\/\" target=\"_blank\" rel=\"noopener\">Bulpitt and Fletcher (1988)<\/a><\/p>\r\n<p><b>Customizing\u00a0Treatment\u00a0<\/b><\/p>\r\n<p>Patients modify treatments to suit their individual needs and preferences.<\/p>\r\n<p>JOHNSON AND BYTHEWAY (2000)\u00a0carried out research and concluded that older people are more likely to buy over the counter medication without prescription.<\/p>\r\n<p>4 categories of medication was found to be more frequent:<\/p>\r\n\r\n<ol>\r\n \t<li>Prevention and maintenance \u2013 vitamins<\/li>\r\n \t<li>Doctor\u2019s alternatives for issues like headache\/indigestion.<\/li>\r\n \t<li>Replacements for prescriptions medicines \u2013 painkillers.<\/li>\r\n \t<li>Medicine to counteract the side effects of prescribed medicines.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<header class=\"entry-header\">\r\n<h1 class=\"entry-title\">Measuring Adherence and\u00a0non-adherence<\/h1>\r\n<\/header>\r\n<div class=\"entry-content\">\r\n<p><strong>Subjective \u2013 Self-reports<\/strong><\/p>\r\n<p>RIEKART AND DROTER (1999)\u00a0developed a technique used to ask questions related to how much patients are adhering to their treatment. It is good for detecting those, who admit to adherence difficulties, but will miss-classify abut 50% of patients, who deny problems or are unaware.<\/p>\r\n<p><b><\/b><b>Strengths<\/b><b>:<\/b><\/p>\r\n\r\n<ul>\r\n \t<li>High Validity\u00a0\u2013 it is asking patients directly about their compliance.<\/li>\r\n \t<li>Way to gather data quickly and cheaply.<\/li>\r\n \t<li>Kaplan &amp; Simon (1990)\u00a0 \u2013\u00a0noted that if the questions are direct and simple to answer, this techniques can be used successfully to measure rates of adherence.<\/li>\r\n<\/ul>\r\n<p><strong>Weaknesses:<\/strong><\/p>\r\n\r\n<ul>\r\n \t<li>Social desirability bias\u00a0\u2013 patients may answer questions in a certain way to appear more socially desirable, which may alter the results and make them less reliable.<\/li>\r\n \t<li>Fixed choices on questions leave little space for explanation from the patient, which make it less valid.<\/li>\r\n<\/ul>\r\n<p><strong>Objective<\/strong><\/p>\r\n<p>CHUN AND NAYA (2000)\u00a0developed a medication dispenser called Tracap, which recorded the date and time a pill left the the bottle. 59 patients took part in the study and were told what the device did but were not told that the research was being conducted. It was found that the adherence rate over 12 weeks was of 71%.<\/p>\r\n<p><b><\/b><b>Strengths<\/b><b>:<\/b><\/p>\r\n\r\n<ul>\r\n \t<li>Reliable\u00a0\u2013 the method has been consistent over time and produces high rates of adherence.<\/li>\r\n \t<li>Good way of measuring without demand characteristics or social desirability affecting the results.<\/li>\r\n<\/ul>\r\n<div class=\"teads-inread sm-screen\">\r\n<div>\r\n<div id=\"teads0\" class=\"teads-player\"><\/div>\r\n<\/div>\r\n<\/div>\r\n<p><strong>Weaknesses:<\/strong><\/p>\r\n\r\n<ul>\r\n \t<li>Low validity\u00a0\u2013 the researchers cannot be sure that the medicine was taken even if it left the bottle.<\/li>\r\n \t<li>Ethical problems\u00a0\u2013 participants did not give full informed consent since they did not know they were being studied.<\/li>\r\n<\/ul>\r\n<p>ROTH (1978)\u00a0developed blood and urine tests to detect the levels of the drug that the patient should have consumed. It is considered one of the best measure for adherence and intake of drugs\/substances.<\/p>\r\n<p><strong>Strengths:<\/strong><\/p>\r\n\r\n<ul>\r\n \t<li>Reliable \u2013\u00a0\u00a0the method is scientific based, therefore it can replicated easily and the same results will be found. Also, demand characteristics or social desirability bias cannot affect the findings.<\/li>\r\n \t<li>Scientific \u2013\u00a0the results cannot be affected by the subjectivity of doctors as they provide quantitative data, which does not need to be analyzed. This makes the results more valid.<\/li>\r\n<\/ul>\r\n<p><strong>Weaknesses:<\/strong><\/p>\r\n\r\n<ul>\r\n \t<li>Expensive\u00a0\u2013\u00a0compared to other methods available, biochemical tests are quite costly because they involve elaborate scientific material.<\/li>\r\n \t<li>The tests do not show total adherence to a regime because it only suggests that enough drug has been ingested to be detectable. Therefore, there is no guarantee if the patient took the right dose and respected the regime.<\/li>\r\n<\/ul>\r\n<p>SHERMAN ET AL (2000)\u00a0developed repeat prescriptions for patients who are on longer-term treatment and have the option to ask for their medicines repeatedly without having to see a doctor and asking for a prescription. The belief is that patients have the motivation to pick up their medicines, then they must be adhering to the regime. However, care takers may pick up the drugs and these may not be consumed by the patient.<\/p>\r\n\r\n<\/div>\r\n<div class=\"entry-content\"><header class=\"entry-header\">\r\n<h1 class=\"entry-title\">Improving Adherence<\/h1>\r\n<\/header>\r\n<div class=\"entry-content\">\r\n<p><strong>Improve Practitioner style\u00a0<\/strong><\/p>\r\n<p>LEY (1988)\u00a0found out ways to improve practitioner style in order to increase adherence:<\/p>\r\n\r\n<ul>\r\n \t<li>Emphasize key information to patients<\/li>\r\n \t<li>Simplify information<\/li>\r\n \t<li>Use straight forward language without medical jargon so that patients do not confuse concepts or feel uneducated.<\/li>\r\n \t<li>Have patients repeat instructions or write them down.<\/li>\r\n \t<li>Use diagrams to represent the treatment\/regime.<\/li>\r\n<\/ul>\r\n<p>For more detailed information \u2013\u00a0<a href=\"https:\/\/alevelpsychologycie.wordpress.com\/2018\/01\/04\/ley-1998\/\" target=\"_blank\" rel=\"noopener\">Ley (1988)<\/a><\/p>\r\n<p><strong>Provide Information\u00a0<\/strong><\/p>\r\n<p>BURKE ET AL (1997)\u00a0reviewed 46 studies of cardiovascular risk-reduction programmes, where a taxonomy was used to classify behaviour change.<\/p>\r\n<p>4 techniques to provide information were highlighted:<\/p>\r\n\r\n<ol>\r\n \t<li>Tailor the regime \u2013\u00a0ensure that the treatment is compatible with the patient\u2019s lifestyle.<\/li>\r\n \t<li>Provide prompts and reminders \u2013\u00a0these could serve as cues so patients are reminded of the treatment like receiving messages.<\/li>\r\n \t<li>Arrange self-monitoring \u2013\u00a0\u00a0ask patients to keep a written record of what they do, this serves as a prompt and increases the chance of them sticking to the treatment.<\/li>\r\n \t<li>Establish a behavior contract \u2013\u00a0\u00a0these must be signed between patient and practitioner to achieve goals and get rewards.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>","rendered":"<header class=\"entry-header\">\n<h1 class=\"entry-title\">Types of Non-adherence and reasons why patients do not\u00a0adhere<\/h1>\n<\/header>\n<div class=\"entry-content\">\n<p>Medical Adherence: the extent to which patients take medications as prescribed by\u00a0 health care providers.<\/p>\n<ul>\n<li>Up to 40% of the population fail to adhere to medical advice.<\/li>\n<li>125,000 people die every year due to failure to comply.<\/li>\n<\/ul>\n<p><strong>Types and extent of non-adherence<\/strong><\/p>\n<p>Clarke (2013)\u00a0noted there are four types of adherence, which were turned into non-adherence types:<\/p>\n<ol>\n<li>Not following short-term advice<\/li>\n<li>Failing to attend a follow-up interview \/\/ referral appointment<\/li>\n<li>Refusing to make a life-style change.<\/li>\n<li>Failing to take preventative health measures.<\/li>\n<\/ol>\n<p><strong>Rational non-adherence<\/strong><\/p>\n<p>Some patients do not adhere to medical advice after making a rational judgement, and find that there are more costs\/risks than benefits of the treatment.<\/p>\n<p>Lada, brien and Jan (2012)\u00a0studied a community of sample patients in Australia and measured the importance of\u00a0<strong>8 medication factors<\/strong>\u00a0through an online survey. The factors were put in order of the most important (1) to least important (8):<\/p>\n<ol>\n<li>Immediate medication harm<\/li>\n<li>Immediate medication benefit<\/li>\n<li>Long-term medication harm<\/li>\n<li>Long-term medication benefit<\/li>\n<li>Cost of treatment<\/li>\n<li>Regimen of treatment<\/li>\n<li>Symptom severity<\/li>\n<li>Alcohol restrictions<\/li>\n<\/ol>\n<div id=\"sf-inline-ad-0\" class=\"ata-frame-wrapper\"><\/div>\n<div id=\"inline-ad-0__controls\" class=\"ata-controls\"><\/div>\n<p>It was concluded that adherence was affected by the way the treatment was sold to patients. E.g. using words like \u2018therapeutic benefits\u2019 rather than \u2018side effects\u2019 would increase compliance.<\/p>\n<p>BULPITT AND FLETCHER (1988)\u00a0found out that when the costs of taking medication outweigh the benefits of treating the problem, mainly asymptomatic ones, patients are less likely to adhere.<\/p>\n<p>It was discovered that the main side effects of medication for hypertension were:<\/p>\n<ul>\n<li>Sleepiness<\/li>\n<li>Laziness<\/li>\n<li>Impotence<\/li>\n<li>Weakened cognitive functioning.<\/li>\n<\/ul>\n<p>For more detailed information \u2013\u00a0<a href=\"https:\/\/alevelpsychologycie.wordpress.com\/2018\/01\/05\/bulpitt-and-fletcher-1988\/\" target=\"_blank\" rel=\"noopener\">Bulpitt and Fletcher (1988)<\/a><\/p>\n<p><b>Customizing\u00a0Treatment\u00a0<\/b><\/p>\n<p>Patients modify treatments to suit their individual needs and preferences.<\/p>\n<p>JOHNSON AND BYTHEWAY (2000)\u00a0carried out research and concluded that older people are more likely to buy over the counter medication without prescription.<\/p>\n<p>4 categories of medication was found to be more frequent:<\/p>\n<ol>\n<li>Prevention and maintenance \u2013 vitamins<\/li>\n<li>Doctor\u2019s alternatives for issues like headache\/indigestion.<\/li>\n<li>Replacements for prescriptions medicines \u2013 painkillers.<\/li>\n<li>Medicine to counteract the side effects of prescribed medicines.<\/li>\n<\/ol>\n<\/div>\n<header class=\"entry-header\">\n<h1 class=\"entry-title\">Measuring Adherence and\u00a0non-adherence<\/h1>\n<\/header>\n<div class=\"entry-content\">\n<p><strong>Subjective \u2013 Self-reports<\/strong><\/p>\n<p>RIEKART AND DROTER (1999)\u00a0developed a technique used to ask questions related to how much patients are adhering to their treatment. It is good for detecting those, who admit to adherence difficulties, but will miss-classify abut 50% of patients, who deny problems or are unaware.<\/p>\n<p><b><\/b><b>Strengths<\/b><b>:<\/b><\/p>\n<ul>\n<li>High Validity\u00a0\u2013 it is asking patients directly about their compliance.<\/li>\n<li>Way to gather data quickly and cheaply.<\/li>\n<li>Kaplan &amp; Simon (1990)\u00a0 \u2013\u00a0noted that if the questions are direct and simple to answer, this techniques can be used successfully to measure rates of adherence.<\/li>\n<\/ul>\n<p><strong>Weaknesses:<\/strong><\/p>\n<ul>\n<li>Social desirability bias\u00a0\u2013 patients may answer questions in a certain way to appear more socially desirable, which may alter the results and make them less reliable.<\/li>\n<li>Fixed choices on questions leave little space for explanation from the patient, which make it less valid.<\/li>\n<\/ul>\n<p><strong>Objective<\/strong><\/p>\n<p>CHUN AND NAYA (2000)\u00a0developed a medication dispenser called Tracap, which recorded the date and time a pill left the the bottle. 59 patients took part in the study and were told what the device did but were not told that the research was being conducted. It was found that the adherence rate over 12 weeks was of 71%.<\/p>\n<p><b><\/b><b>Strengths<\/b><b>:<\/b><\/p>\n<ul>\n<li>Reliable\u00a0\u2013 the method has been consistent over time and produces high rates of adherence.<\/li>\n<li>Good way of measuring without demand characteristics or social desirability affecting the results.<\/li>\n<\/ul>\n<div class=\"teads-inread sm-screen\">\n<div>\n<div id=\"teads0\" class=\"teads-player\"><\/div>\n<\/div>\n<\/div>\n<p><strong>Weaknesses:<\/strong><\/p>\n<ul>\n<li>Low validity\u00a0\u2013 the researchers cannot be sure that the medicine was taken even if it left the bottle.<\/li>\n<li>Ethical problems\u00a0\u2013 participants did not give full informed consent since they did not know they were being studied.<\/li>\n<\/ul>\n<p>ROTH (1978)\u00a0developed blood and urine tests to detect the levels of the drug that the patient should have consumed. It is considered one of the best measure for adherence and intake of drugs\/substances.<\/p>\n<p><strong>Strengths:<\/strong><\/p>\n<ul>\n<li>Reliable \u2013\u00a0\u00a0the method is scientific based, therefore it can replicated easily and the same results will be found. Also, demand characteristics or social desirability bias cannot affect the findings.<\/li>\n<li>Scientific \u2013\u00a0the results cannot be affected by the subjectivity of doctors as they provide quantitative data, which does not need to be analyzed. This makes the results more valid.<\/li>\n<\/ul>\n<p><strong>Weaknesses:<\/strong><\/p>\n<ul>\n<li>Expensive\u00a0\u2013\u00a0compared to other methods available, biochemical tests are quite costly because they involve elaborate scientific material.<\/li>\n<li>The tests do not show total adherence to a regime because it only suggests that enough drug has been ingested to be detectable. Therefore, there is no guarantee if the patient took the right dose and respected the regime.<\/li>\n<\/ul>\n<p>SHERMAN ET AL (2000)\u00a0developed repeat prescriptions for patients who are on longer-term treatment and have the option to ask for their medicines repeatedly without having to see a doctor and asking for a prescription. The belief is that patients have the motivation to pick up their medicines, then they must be adhering to the regime. However, care takers may pick up the drugs and these may not be consumed by the patient.<\/p>\n<\/div>\n<div class=\"entry-content\">\n<header class=\"entry-header\">\n<h1 class=\"entry-title\">Improving Adherence<\/h1>\n<\/header>\n<div class=\"entry-content\">\n<p><strong>Improve Practitioner style\u00a0<\/strong><\/p>\n<p>LEY (1988)\u00a0found out ways to improve practitioner style in order to increase adherence:<\/p>\n<ul>\n<li>Emphasize key information to patients<\/li>\n<li>Simplify information<\/li>\n<li>Use straight forward language without medical jargon so that patients do not confuse concepts or feel uneducated.<\/li>\n<li>Have patients repeat instructions or write them down.<\/li>\n<li>Use diagrams to represent the treatment\/regime.<\/li>\n<\/ul>\n<p>For more detailed information \u2013\u00a0<a href=\"https:\/\/alevelpsychologycie.wordpress.com\/2018\/01\/04\/ley-1998\/\" target=\"_blank\" rel=\"noopener\">Ley (1988)<\/a><\/p>\n<p><strong>Provide Information\u00a0<\/strong><\/p>\n<p>BURKE ET AL (1997)\u00a0reviewed 46 studies of cardiovascular risk-reduction programmes, where a taxonomy was used to classify behaviour change.<\/p>\n<p>4 techniques to provide information were highlighted:<\/p>\n<ol>\n<li>Tailor the regime \u2013\u00a0ensure that the treatment is compatible with the patient\u2019s lifestyle.<\/li>\n<li>Provide prompts and reminders \u2013\u00a0these could serve as cues so patients are reminded of the treatment like receiving messages.<\/li>\n<li>Arrange self-monitoring \u2013\u00a0\u00a0ask patients to keep a written record of what they do, this serves as a prompt and increases the chance of them sticking to the treatment.<\/li>\n<li>Establish a behavior contract \u2013\u00a0\u00a0these must be signed between patient and practitioner to achieve goals and get rewards.<\/li>\n<\/ol>\n<\/div>\n<\/div>\n","protected":false},"author":142337,"menu_order":4,"template":"","meta":{"_candela_citation":"[]","CANDELA_OUTCOMES_GUID":"","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-269","chapter","type-chapter","status-publish","hentry"],"part":99,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters\/269","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/users\/142337"}],"version-history":[{"count":1,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters\/269\/revisions"}],"predecessor-version":[{"id":270,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters\/269\/revisions\/270"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/parts\/99"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapters\/269\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/media?parent=269"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/pressbooks\/v2\/chapter-type?post=269"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/contributor?post=269"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/wp-json\/wp\/v2\/license?post=269"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}