adherence to medical advice chapter 4. adherence adherence refers to the patient’s ability and...
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Adherence to Medical Advice
Chapter 4
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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?