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Features of adherence to medical regimes

Healthy Living
by

Rajiv Ariaraj

on 6 October 2015

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Transcript of Features of adherence to medical regimes

Features of Adherence

to medical regimes and supporting evidence
Reasons for non-adherence:
cognitive rational non-adherence
Measures of non-adherence:
physiological
Improving adherence using behavioural methods
Heathy Living:
What is adherence?
Adherence is the extent to which a patient obeys medical advice from medical practitioners.
So far, we have covered:
Theories explaining why people act healthy or not.
How to promote good health in different ways.
This next section is about
non-adherence
.
What do you think that means?
Non-adherence is when patients do not listen to medical advice.
Why would people not listen to medical advice?
Have you ever ignored medical advice?
Possible reasons for non-adherence
Embarrassment
Forgetfulness
Unclear instructions on medication
Cost
Unpleasant taste of medication
Complicated regime
Side effects
Disruption to everyday life
Unclear on purpose of treatment
Feeling like the treatment isn't working
Physical difficulties in using medication
Think of the 3 theories of health belief:
Note down how each of them could explain why patients would not listen to medical advice.
Bulpitt
Investigated medication for hypertension.
He used a "Review Article" research method.
Not PittBull.
Review articles are then a researcher does not carry out any new research but investigates many old studies and looks for common trends in the results.
et al (1988)
Today's Tasks
Read and summarise the Bulpitt study on paper.
In PAIRS have a go at the evaluation questions.
Sometimes people don't listen to medical advice because they just don't understand the problem.
Other times, people are fully aware of the issues and choose not to adhere.
This is called:
Cognitive Rational Non-Adherence
(which is what this whole section is about)
To understand whether or not people are adhering to medical advice we need to find a way to...
Measure people's adherence
Imagine your are measuring an individual's adherence to blood pressure pills.
Try to think of several different methods (at least 4) that you could use to measure their adherence to the blood pressure pills.
Cluss and Epstein (1995)
Identify 6 methods that you could use to measure adherence:
Self Report
Therapeutic Outcome
Assessing how adherent a patient has been seeing if they have recovered from their illness.
Health Worker Estimates
Asking the doctor how adherent they've been
Pill and bottle count
Counting the pills left in the bottle and comparing it with the number that should be there.
Mechanical Methods
Some devices and electronically count how many times pills have been removed from a bottle.
E.g. Blood Tests
Physiological Tests
Can measure the amount of medication in someone's body.
What is the most effective method?
Braam et al (2008)
Investigated different methods of measuring adherence in patients who were taking pills for high blood pressure.
30 Patients were taken from a medical centre. They had been taking blood pressure medication for at least 4 weeks (however it wasn't working)
Where is this?
Read and summarise the study in your packs.

Complete the Evaluation pages.
We know reasons why people might not adhere to medical treatment.
and we know effective ways of measuring non-adherence
So how can we improve adherence?
This is Jane
She suffers from asthma, but she often forgets or doesn't care about using her inhaler.
What can you do to make sure that Jane adheres to her medical regime?
Watt et al (2003)
looked into ways of improving adherence of inhaler use of asthmatic children in Australia.
32 children with asthma in Australia
Mean age 3.2
Consent came from parents
Sample
For one week the children were given a regular inhaler (the Breath-A-Tech)
During the second week the children were given a new type of inhaler designed to be more "fun"
Fun...
Haler!
Summarise Watt et al (2003) and complete the evaluation questions on page 27 and 28 of your pack.
Complete revision sheet 3
Behavioural Techniques
Summarise what the following mean:
Postive Reinforcement
Negative Reinforcement
Punishment
Bonus Task
How could you use behavioural techniques to:
Stop a child from eating fast food.
Make someone drink more water.
Help people eat their 5 a day.
+
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