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Part 3- L7.docx

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University of Otago
Gareth Treharne

Part 3- L8 Adherence to medication- freedom to choose? Why is taking medication important? - Medications only work if they are taken - Suboptimal dosage of required medications can lead to o Waste of products o Worsening health status o Need for more appointments or more intense treatments o Premature death Defining compliance - Taking medications exactly as prescribed o That is what you should do exactly. o It not what you want to do but what you think you should do - Compliance: “yielding to a desire, request” - In the healthcare setting o The degree to which a patient complies with or follows explicitly the expert treatment recommendations of a health professional. - No compliance can be o Unintentional o Purposeful Paternalism in biomedicine - The term compliance reinforces a power differential: o The physician alone makes the treatment decision, while the passive and dependent patient is obliged to comply o Referred to as paternalism  Parent and child - The paternalistic model of healthcare o Healthcare interactions can be modelled as follows  The healthcare professional accesses the patient  The healthcare professional make a treatment decision based on this assessment  The healthcare professional provides a prescription  The patient collects the prescription (or not)  The patient then complies (or not) o The patient is being treated like a child. Told what to do. o And then patient doesn’t do it = not complying o Core of the process of paternalism  Prescription  May not get it or take them  This is where compliance starts Adherence - Newer terminology increasing in use - Steady observation or maintenance - In the healthcare setting it is the degree to which patients choose to adhere to, rather than comply with, medical recommendations for treatment - Non-adherence has the same problem as non-compliance but is less accusatory (severe harsh) - Poor adherence in the DSM5 o Psychological factors affecting other medical conditions o Criteria  Having a medical consition symptom (not a medical disorder)  Psychological or behavioural factors adversely affect the medical condition cause health risks including poor adherence  Not better explained by a mental disorder o Can be enforced in compulsory treatments o Not seen as a medical problem but given medicines o Whether or not someone takes their medication is a psychiatric problem too as well as the disorder  I.e. Force feeding anorexic patients.  Serious breach of physical space - The scope of non-adherence o Only 50% of people with a chronic illness are adherent  they won’t stick to the medications  Estimation not exact o An estimate- drawn mainly from research among individual in economically-more- developed countries  Evidence from 1st world countries  More about the assumption that the medicines are available  Do these people have very bad conditions or is it just minor like a cold o The non-adherence rate depends on variations of  The medication  Frequency  Toxicity  Associated costs  The sample  Illness(es) in questions  The location of patients motivation to participate in research and behave as directed  Operationalization  Assessment of adherence - Study on non-adherence o 239 patients from 23 community pharmacies in south east of England o Either  Aged >75 years  Aged 18-75 years old  Diagnosed with heart disease (57%) or stroke (3%)  Asthma (16%), arthritis (8%) or diabetes (7%) o Very mixed sample o Took part in a structured telephone interview exactly 10 days after their prescription had been filled o Results  6% had stopped the medication on medical advice  30% had missed at least one dose of the medication in the last week  55% unintentionally (17% of sample)  45% purposefully (13% of full sample)  8% had taken absolutely none of the medication  66% of those still taking the medication reported at least one problem with it  50% had side-effects (33% of sample)  43% had concerns about the medication (28% of sample)  7% had difficulties with the practicality of taking the medications, including: o Trouble removing the medication from the container  I.e. if arthritis tried to take medication out it would be very difficult o Trouble remembering a complicated combination of medications and timing (on rising, after breakfast etc.)  61% wanted more information  43% wanted more information on their meds (26% of sample)  28% wanted more information of their illness (17% of sample)  29% were unsure (18% of sample)  Many people with a chronic (physical) illness have information need or problems adhering to new medication  Very few patients were adherent, problem-free and had no info
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