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Adherence to Medical Advice

Adherence to Medical Advice

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Adherence to Medical Advice

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  1. Adherence to Medical Advice Chapter 4

  2. 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

  3. Theories • Cognitive Behavioral is Most Explanatory • Awareness - Precontemplation • Attitude – Contemplation/Preparation • Susceptibility • Severity • Cost/Benefit • Barriers – Preparation • Adherence – Action/Maintenance

  4. Factors Predicting Adherence • Illness Characteristics • Severity of Disease • Level of Distress (Pain) • Treatment Characteristics • Side-effects • Duration • Complexity

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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?