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PSYC 3110 (51)
Chapter 18

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PSYC 3110
Kieran O' Doherty

Chapter 18 Character of adherence -compliance: the extent to which the patient passively accepted the physicians instructions on medicine taking  adherence: a neutral expression Extent of adherence -most people do not adhere to specific medical or health-care directives at least not fully -50-75 percent of patients do not adhere to medical advice  14-21 % of patients do not fill their prescriptions  60% of all patients cannot identify their own medication  30-50% of all patients ignore or compromise medication instructions  12-20% of patients take other peoples medication Factors associated with non-adherence Patient characteristics -less social support and the more social isolated the patients are, the less likely they are to follow medical directives -individuals who came from unstable families were also found to be less compliant with medical treatment -adherence associated with higher social support -Hulka (1979) found no consistent relationship between age, sex, marital status, education, number of people in the household, social class and adherence -the more the prescribed medication accords with the patients beliefs system the more likely they are to comply with the treatment -According to the Health Belief Model (the extent to which the person adhere with certain medication advice depends upon perceived disease severity ,susceptibility to the disease, benefits of the treatment recommend and barriers to follow the treatment -effectiveness greater than barriers in treatment adherence -Social learning theory -internal locus of control predicted adherence to a weight-control programme for patients with diabetes, its importance was small and depended on the degree of social support -patients predictions concerning their adherence (Self-efficacy expectations) with treatment predicted actually adherence Disease Characteristics - Certain disease characteristics have been found to be associated with adherence  severity of the disease and visibility of the symptoms  when symptoms are unwanted and obvious, the person is more likely to comply with treatment that offers a promise of removing them  when prognosis is poor there is evidence that the rate of adherence is reduced Treatment factors associated with non-adherence Preparation for treatment -characteristic of treatment setting -long waiting time -long time elapsed between referral and appointment -timing of referral -absence of individual appointment times -lack of cohesiveness of treatment delivery systems Immediate character of treatment -characteristics of treatment recommendations -complexity of treatment regimen -duration of treatment regimen -degree of behavioral change -characteristics of medicine Administration of treatment -inadequate supervision by professional -absence of continuity of care -failure of parents to supervise drug administration Consequences of treatment -medication side effects -social side effects the more complicated the treatment prescribed the less likely the patient is to comply -although physicians may explain the treatment, patients frequently do not understand or forget the instructions provided -Ley (1979) found that at least 1/3 of the info given by their physician is forgotten -adherence declines with an increase in the number of medications or doses and with the length of recommended treatment  Masur suggested that it wasn’t the length but this decline but the absence of symptoms -understanding how the patient feels about a particular procedure or treatment is a necessary step in improving adherence Interpersonal factors -physician-patient communication have been classified as either “patient-centered” or authoritarian.  Patient centered or affliative style is designed to promote a positive relationship and includes behaviors such as interest, friendliness and empathy Authoritarian or control-orientated style is designed to maintain the physicians control in the interaction Patient satisfaction was associated with perceived interpersonal competence, social conversation and better communication as well as more information and technical competence Social and Organizational Setting -regular follow-up by physician increases adherence  it is also greater when the referral to a specialist is seen as part of the assessment rather than as a last resort, when appointments are individualized and waiting times are reduced  if family remind and assist the patient concerning their medication it would be expected that the patient would be more compliant  adherence higher in cohesive families and lower in families with conflict Alternatives to Adherence Modern Medicine - patient non-adherence is a result of ignorance and or deviance  according to reactance theory individuals believe they have the right to control their own behavior  people like to feel in control of their lives and free  non compliance can thus be interpreted as a means of resisting medical dominance  older patients more accepting and accommodating vs. younger and more educated Role of the physician -in traditional non-western societies the physician maintains the dominant role and the patient is more inclined to adopt a compliant stance -in western society the demand for greater control over ones life with the traditional passive role and leads to greater resistance to medical advice -limits of medicines role and the importance of building links to other forms of praxis that seek to change the social context of medical encounters Lived Experience of Chronic Illness Self-Regulation -individuals with chronic illness actively monitor and adjust their medication on an ongoing basis Reasons for self regulation of medication -testing: the way patients test the impact of varying dosages controlling dependence: the way patients assert themselves an others that they are not dependent on the prescribed medication destigmatization: an attempt to reject the illness label and be normal -practical practice: the way patients modified their dosage so as to reduce the risk of seizures, eg. Increasing the dosage in high stress situations -people do not simply follow the standardized instructions provided by the physician but rather adjust them to suit their own personal needs -patients attitude to the recommended treatment is interwoven with their attitude to the illness and their attitude to their physician Self-Regulatory Model of Illness: whether a person adopts a certain copying procedure ( adherence with medication) depends upon perception of illness threat and the perceived efficacy of the copying strategy  Concrete symptoms experience is importance in formulating both representation of the disease and in monitoring medication efficacy  Perceived lack of evidence of the disease or of efficacy of the medication would encourage non- adherence  How necessary the medicine is adheres to adherence Dynamic extended model of treatment and illness representations ( Figure 18.1 pg. 424) This model conceives of the patient as being involved in ongoing review of the treatment to assess its effectiveness and the value of continued treatment -positive perceptions of ones therapist as well as a belief that the illness was not caused by mental factors predicted adherence to appointments -beliefs about the value of holistic health and difficulty attending appointments predicted adherence to remedies prescribed Fear of Medication -reluctant to follow described treatment for these reasons:  Fear of side-effects  Fear of dependency  Fear of reduced effectiveness  Did not fit with lifestyle  Drugs as a sign of we
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