Adherence to medical advice

TYPES OF NON-ADHERENCE AND REASONS WHY PATIENTS DO NOT ADHERE

Patients will visit their doctors to ask for guidance. While some patients will receive instructions on how to handle their problem, others might leave with a prescription. Others may be told to come back for tests. However, not all patients follow their doctor’s medical guidance. This is known as a lack of adherence. According to Sarafino (2006), up to 40% of a population (2 in 5 people) fail to adhere to medical advice given to them. Sarafino also discovered that adherence is higher in people just before or just after seeing a doctor.

Types and extent of non-adherence

Clarke (2013) noted different types of adherence, which are:

  • Following short-term advice
  • Attending follow-up interviews and referral appointments
  • Making lifestyle changes
  • Engaging in preventative health measures

Based on the above, we can list the following types of NON-adherence:

  • Not following short-term advice
  • Failing to attend follow-up interviews and referral appointments
  • Refusing to make lifestyle changes
  • Failing to take preventative health measures

Rational non-adherence

Some patients do not adhere to medical advice after making a seemingly rational judgement; usually, they conduct a cost-benefit analysis and find that there are more costs/risks than benefits to following the advice.

Laba Brien and Jan (2012) researched rational non-adherence. They collected a sample of Australian patients and gave them an online survey to complete. The survey measured the importance of 8 medication factors and their role in non-adherence.

The 8 factors were:

  1. Immediate medication harm
  2. Immediate medication benefit
  3. Long-term medication harm
  4. Long-term medication benefit
  5. Cost
  6. Regimen
  7. Symptom severity
  8. Alcohol restrictions

The researchers found that symptom severity and alcohol resrictions did not affect adherence, but the other 6 factors did. Furthermore, it was noted that patients were more likely adhere to advice if the term “therapeutic benefits” was used instead of “side effects”. This is because rational patients do not want side effects when taking medication; they see “therapeutic benefits” more positively. Thus, we can conclude that the way a treatment is “sold” to the patient also affects their adherence.

Bulpitt and Fletcher (1988)

Bulpitt and Fletcher reviewed non-adherence in patients who were given medication to regulate hypertension (high blood pressure). The review looked at: physical side effects, psychological side effects, problems at work, and effects on physical well-being. The researchers found that medication for hypertension had many side effects, including sleepiness, dizziness, impotence (problems with sexual performance), and weakened cognitive functioning. It was concluded that patiences are less likely to adhere if the side effects (costs) outweigh the benefits of a treatment of problems that are mostly asymptomatic – in this case, hypertension. Also, men were more likely to reject the medicine due to its negative effect on sexual performance.

Sarafino (1994)

Sarafino summarised the reasons why a rational patient might not adhere to medical advice:

  • They have a reason to believe the treatment is unhelpful
  • The treatment’s side effects are unpleasant, worrying or reducing quality of life
  • They are confused about when and how much of the treatment is required
  • They face practical barriers, such as treatment cost

The above reasons show that rational patients who do not adhere to medical advice are not being ignorant or uncooperative; rather, they are trying to deal with their illness in the way they best understand.

Customising treatment

Customise means to modify something to make it more personalised for an individual. For example, you might customise a baby hat by sewing the baby’s name on the front or customise your car by adding new features that you like.

Customising treatment means modifying a treatment to suit the individual needs and preferences of a person.

Johnson and Bytheway (2000)

Previous research shows that older people are more likely to buy over-the-counter (without prescription) medication. Johnson and Bytheway conducted a study on elderly British patients and found that their over-the-counter medication fell into four categories:

  1. Prevention and maintenance (e.g. vitamin supplements)
  2. Doctor alternatives for issues like headaches and indigestion
  3. Replacements for prescription medicines (e.g. painkillers)
  4. Medicine to counteract side effects of prescribed medicine (e.g. laxatives for constipation caused by prescribed painkillers)

 

MEASURING ADHERENCE/NON-ADHERENCE

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Subjective: self reports

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Riekart and Droter (1999)

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Objective: pill counting

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Chung and Naya (2000)

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Biochemical tests

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Roth (1987)

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Repeat prescriptions

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Sherman (2000)

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