Adherence to medical advice
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Adherence to Medical Advice. Chapter 4. Adherence. Adherence refers to the patient’s ability and willingness to follow recommended health practices . It is an issue of MAINTENANCE In general nonadherence remains at about 50% across a number of different health behaviors. Theories.

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Adherence l.jpg
Adherence

  • Adherence refers to the patient’s ability and willingness to follow recommended health practices.

  • It is an issue of MAINTENANCE

  • In general nonadherence remains at about 50% across a number of different health behaviors


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Theories

  • Cognitive Behavioral is Most Explanatory

    • Awareness - Precontemplation

    • Attitude – Contemplation/Preparation

      • Susceptibility

      • Severity

      • Cost/Benefit

    • Barriers – Preparation

    • Adherence – Action/Maintenance


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Factors Predicting Adherence

  • Illness Characteristics

    • Severity of Disease

    • Level of Distress (Pain)

  • Treatment Characteristics

    • Side-effects

    • Duration

    • Complexity


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Predictors of Adherence

  • Age

    • Interaction effect

    • Curvilinear relationship

      • below 55, around 70, over 80

  • Gender

    • Women sometimes better (exercise)

  • Social Support

    • Positive relationship

  • Cultural Norms


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Factors Predicting Adherence Practitioner-Patient Relationship

  • Communication – How the message is delivered

    • Verbal

      • Simple language

      • Importance

      • Have patient repeat

      • Partnership statements

      • Positive statements

      • Waiting

    • Nonverbal

      • Eye-contact

      • Smiling

      • Leaning forward


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Factors Predicting Adherence: Practitioner-Patient Relationship

  • Clinician characteristics – Who is delivering it

    • Technical ability

      • Males perceived to be > than females (NOT TRUE)

    • Warm, caring, friendly, & interested in the patient

      • As a group female physicians better at these than males


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Improving Adherence

  • Education is ineffective alone

  • Self-monitoring

  • Prompts-cued by regular events, calls, beepers, etc.

  • Tailor regimen to fit the treatment to the patient’s life.

  • Graduated regimen implementation.

  • Contingency Contract - agreement for a reward based on behavior

  • Home Visits

  • Support Groups


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Effectiveness of adherence

  • Correlational studies show poor adheres 2 1/2 time more likely to die than good adherers.

  • Some self-report studies inconclusive

  • Noise in the data

  • What is the outcome measure?


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