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Adhering to Medical Advice

Adhering to Medical Advice

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Adhering to Medical Advice

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  1. Adhering to Medical Advice

  2. Basic ideas • Do not take left over medications • Do not stop taking medicine whenever you begin to feel better • Do not quit your medication even if you feel worse after taking it • Even if it makes you feel bad, take the medicine anyway

  3. Theories for adherence (Compliance) • Behavioral theory • Self-efficacy theory • Transtheoretical model

  4. Behavioral theory • Operant conditioning • Reinforcement • Positive • Negative • Punishment • Rewards • Extrinsic • Intrinsic

  5. Self-efficacy theory • Bandura’s Reciprocal determinism • Person (thinking) + Behavior + Environment • Self-efficacy (Person) • Perceived control over yourself and your environment • Situation specific

  6. Self-efficacy • Beliefs predict accomplishment • Acquired, increased, or decreased by: • 1. Performance • 2. Vicarious experience • Seeing others of similar skills perform • 3. Encouragement • 4. Physiological arousal • Anxiety, or high expectation

  7. The Transtheoretical Model • Stages of change model • 1. Precontemplation stage • Has not thought about changing • 2. Contemplation stage • Only thought about changing • 3. Preparation • Thoughts & preparation for change • 4. Action stage • Actually making the change • 5. Maintenance stage • Resists temptation to go back

  8. How do you measure adherence? • 1. Ask Practitioner • 2. Ask patient • 3. Ask others • 4. Monitor medication • 5. Biochemical evidence • 6. Combination of these

  9. Accuracy of measurement • 1. Practitioner • Slightly better than chance • 2. Patient • Inaccurate because: • Do not know • Lie to exaggerate success • 3. Others • Constant observation is impossible • Artificial - Unrealistically high reports • 4. Medicine usage • Patient may not have taken the medication • 5. Biochemical evidence (blood, urine) • People vary in response to drugs

  10. What factors predict adherence? • 1. Severity of disease • 2. Treatment characteristics • 3. Personal characteristics • 4. Environmental factors • Cultural norms • Social support

  11. Severity of disease • Pain is most likely to produce compliance with medical advice

  12. Treatment characteristics • Difficult, complicated, or painful treatments reduce compliance

  13. Personal characteristics • Compliance • Depends on the situation • Is not a global personality trait • Belief that treatment of ineffective or harmful • Decreases compliance

  14. Environmental factors • Social support - increases compliance • Living with a family • Being married

  15. Improving adherence • Clearly written instructions • Verbal rewards • Prompts from patient’s spouse • Simple prescriptions