Adherence to Medical Advice

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Adherence to Medical Advice

• Chapter 4

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Adherence

• Adherence refers to the patients 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-Patien
t Relationship

• Clinician characteristics Who is delivering it
• Technical ability
• Males perceived to be gt 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
  patients 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?