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30 Cards in this Set
- Front
- Back
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what is concordance? |
process of shared decision making about treatment |
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what are the types of nonadherence exist? |
- Initiation: collecting treatment and taking the first dose - Implementation: timing/ drug holidays, diet, dose, behavior - Persistence: taking the full course - Discontinuation |
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how do you identify who isn't taking their medications? |
- pharmacy refill - self report - new technology |
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explain pharmacy refill what are the pro and con? |
pharmacy refill examines pharmacy records to identify whether patients have collected their medication pro; objective con; not actually a measure of medication taking |
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explain self report what are pro and con? |
validated questionnaires (58 questions) for measuring medication adherence pro; easy, validated con; reporting bias, can be time consuming, didn't often separate different types of nonadherence |
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explain new technology |
new approach that detects adherence by pill with sensor etc pro; very detailed information con; expensive |
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Explain the theoretical model of adherence: perceptions and practicalities approach (PAPA) |
they are composed of two types of non-adherence unintentional non-adherence; caused by the capacity and resources, leading to practical barriers intentional non-adherence; caused by motivational belief and preferences, leading to perceptual barriers Both can happen at the same time |
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what do you mean by capacity and practical barriers? |
- cost - distance to pharmacy - being able to access your medication (such as pill caps, injections) - more complex regimens |
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what are the cognitive representations of illness? |
cause; genetic, environmental, chance control; treatment timeline; chronic, short term, episodic identity; symptoms that form part of the illness consequences; physical, expected emotional, social |
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Explain the common sense model leventhal and leventhal 1980 |
check moodle |
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what are the general beliefs about medicines? |
- Harm; medicines are typically dangerous - Overuse; doctors overprescribe medicines - Benefit; medicines are positive for society - Personal sensitivity to medicines; I am generally vulnerable to side effects
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what are the specific beliefs about a particular treatments? |
- Necessity; will it help improving my illness? - Concerns; will it cause me adverse effects? |
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Explain the necessity-concern framework |
Low adherence is noticed when - doubts about personal necessity of medication and - concerns about potential adverse effects |
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Explain the poor approach intervention design "WTIWAGIAT" |
"We Thought It Was A Good Idea At Time" 1) Don’t consider existing evidence for and againstyour intervention, just do what you think is best 2) Treat your patients like a black box- you can’tunderstand why they do what they do 3) Ignore the context of your intervention, just focus on theindividual patients in the pharmacy 4) Treat patients like they are all the same 5) Don’t evaluate your intervention 6) Don’t consider the costs or burden your intervention mightplace on patients or healthcare providers. 7) Don’t tell anyone what you’ve done or if it has worked |
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What are the three steps to successful intervention design? |
Step 1: Have a theory of why your patients aren't adhering Step 2: Develop your intervention focused on this and existing evidence Step 3: Report your intervention to help others |
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what are the factors that adherence intervention acts upon? |
- target patient - target healthcare providers - target caregivers - target healthcare system |
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Step 2: what are the types of evidence can we use? |
- RCTs (randomized controlled trials) - Cohort study - Cross sectional study - Meta-analysis |
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what is randomized controlled trial? |
‘a number of similar people are randomly assigned to 2 (ormore) groups to test a specific drug or treatment. Onegroup (the experimental group) receives the treatmentbeing tested, the other (the comparison or control group)receives an alternative treatment, a dummy treatment(placebo) or no treatment at all. This method is also usedto reduce bias.’
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what is cohort study? |
‘A study with 2 or more groups of people - cohorts- with similar characteristics. One group receivesa treatment, is exposed to a risk factor or has aparticular symptom and the other group does not.The study follows their progress over time andrecords what happens’
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what is cross sectional study? |
‘A 'snapshot' observation of a set of people at 1time. This type of study contrasts with alongitudinal study, which follows a set of peopleover a period of time.
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what is meta-analysis? |
‘A review in which evidence from scientific studieshas been identified, appraised and synthesised ina methodical way according to predeterminedcriteria. Statistical techniques are then used tointegrate the results of included studies. ’
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Rank these techniques in terms of the level of evidence |
[strong evidence] >>>>> [weak evidence] [Meta-analysis]>[RCTs]>[Cohort study]> [cross sectional study]>[case series/ reports/ opinions/ ideas] |
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Step 3 what are the specific intervention techniques for adherence? |
1. motivational interviewing 2. changes to medication packaging 3. Providing information |
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what is motivational interviewing? |
- Acceptance that the decision is in the hands of the patient
- Reflecting what patient has said especially ambivalence e.g. ‘you said that you find it hard to find time to exercise and youwant to walk more’‘it sounds as though you are unsure whether you want to make thischange’ - Open questions elaborating ‘change talk’e.g. How? What? When? - Empathy for the patient even if they are resistant ‘rollingwith resistance’ |
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what is changes to medication packaging? |
One of the commonest interventions in clinical practice especially with elderlypatients Review of old style packages:(Mahtani et al., 2011)- 12 studiesOverall 11% more pills takenin reminder packages
MEMS cap can be used to monitor adherence Electronic monitoring (e.g. MEMS caps, smartinhalers) withfeedback from 18 studies- Mean increase in adherence 9.4% |
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what is providing info? |
Many adherence interventions involveproviding information!
Differ in: - Information content (e.g. focus on illness, sideeffects, nonadherence) - Delivery (online, telephone, mailed leaflet, doctor,nurse, pharmacist etc) - Format (pictures, numbers, video, audio) - Tailoring |
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In terms of sharing your interventions to others, what you should provide as the essential information? |
TIDIER: 3 items
Item 3. What (materials): Describe any physical or informational materials usedin the intervention, including those provided to participants or used in interventiondelivery or in training of intervention providers. Provide information on where thematerials can be accessed (for example, online appendix, URL) Item 5. Who provided: For each category of intervention provider (for example,psychologist, nursing assistant), describe their expertise, background and anyspecific training given Item 6. How: Describe the modes of delivery (such as face to face or by someother mechanism, such as internet or telephone) of the intervention and whether itwas provided individually or in a group |
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what are the factors influencing the person to recognize what information is effective? In terms of source |
- credibility (such as trust and expertise) - attractiveness - power |
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what are the factors influencing the person to recognize what information is effective?
In terms of message |
- clarity - engaging - imaginable - framing - tailored |
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what are the factors influencing the person to recognize what information is effective? in terms of patient |
- literacy/ numeracy - attention - belief - perception of source and message |
