Transcript improving adherence

Improving adherence.
Provide more information about the drugs
and the treatment.
 Tailored regimens are easier to comply
with, and there has been some encouraging
results (e.g. Haynes et al, 1979).
 Get the doctor to improve communication
and to be warm and sensitive.
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Get the patients to ask more questions so that they
get more information.
This will help to prevent false beliefs.
It also improves patient satisfaction with the
doctor, and thus compliance.
Some patients may not know what to do if they
miss taking some tablets.
Others may not know when they could expect to
feel better.
Ley et al 1976
Three different types of leaflets were given
to patients.
 One was easy to understand, another was
moderately difficult and the other was very
difficult to understand.
 Compliance increased for those patients
who were given easy or moderately difficult
leaflets (Ley et al 1976).
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(Belisle et al, 1987).
Just informing patients about their illnesses
will not necessarily increase compliance.
 Patients suffering from hypertension
viewed a slide show and read a booklet
about hypertension and its treatment,
emphasising the benefits of treatment and
regular medication.
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(Belisle et al, 1987).
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Despite this greater understanding there were no
differences in compliance or effectiveness of
blood pressure control between patients who had
and had not been given the educational program.
However, programs that provide information
about the problems people will face in trying to
adhere to a regimen and focus on changing
peoples interpretation of their relapses have been
more successful in promoting compliance (Belisle
et al, 1987).
Increase the frequency of visits to the
doctors. This would increase positive
reinforcement.
 The patient would comply because they
would not wish to be scolded by the doctor.
 Some studies have found compliance to
increase by up to 60 percent (e.g. McKenny
et al., 1973).
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When supervision is reduced, so is
compliance.
 For example, non-compliant hypertensive
patients were asked to keep a record of their
blood pressure and compliance was
increased as a result.
 This only happened when the records were
checked on a regular basis.
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Nessman et al (1980)
Nessman et al (1980) group sessions are
more effective.
 In this experiment the treatment was for
hypertension (high blood pressure).
 Compliance increased from 38% to 88%.
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Nessman et al (1980)
The result could be misleading because the
researchers were only able to persuade 56
people out of a possible 500, to take part!
 They could have been highly motivated
from the start!
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information sheets and treatment
programmes
One factor that might improve adherence is
designing information sheets and treatment
programmes that are easy to understand and
carry out.
 An important aspect of this is to consider
the special needs of different client groups.
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information sheets and treatment
programmes
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Old people, for example, often have
different understandings and health beliefs
to young people.
information sheets and treatment
programmes
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Kaplan et aI. (1993) identifies three problems for
old people in following treatment programmes:
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i)
Some old people have difficulty understanding
and following complex instructions. Although ageing is
not necessarily related to mental decline, some old
people develop cognitive problems, such as memory
loss, which make it more difficult to follow treatment
programmes.
ii)
Older people sometimes have difficulty with
medicine containers because they lack the manual
dexterity to deal with childproof caps. It has been noted
that older people sometimes get over this problem by
transferring the tablets to other containers, and this can
lead to confusion about which tablet is which.
information sheets and treatment
programmes
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iii)
Older people are sometimes on a range
of medications for different conditions and
these might be prescribed by different doctors.
This increases the risks of unpleasant sideeffects, and so increases the chance that the
patient will decide to discontinue the treatment.
Improving
communication
(Sarafino 1994).
1. Simple verbal instructions, simple language
(no jargon).
2. Give specific instructions, not general ones.
3. Emphasise key information.
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Improving
communication
4 Give simple written instructions.
5 Get the patient to repeat the instructions in
their own words.
6 Break down the information into stages.
get the patient to follow a simple regimen
at first, and then add to this later.
(Haynes, 1982).
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This will help for short-term regimens more
than long-term (Haynes, 1982).
Kulik and Carlino (1987)
Kulik and Carlino (1987) found that by
getting children to promise to take the
medicine, significantly more children
complied as ascertained by urine samples
and interviews with parents.
 Control children were told to take the
medicine, but the doctor did not ask the
child to promise.
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Kulik and Carlino (1987)
The children were randomly allocated to the
two groups.
 The children were followed up 10 days
later.
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The health worker
The health worker has a central role.
 They can tailor the message to the
individual lifestyle of the patient.
 Face to face contact will increase cooperation.
 Can get other family members to help out.
 Progress can be monitored.
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Behavioural methods
feedback - regular reports can reinforce
compliant behaviour.
2. Self-monitoring - patient keeps a written
record.
3. Tailoring the regime - fitting in the
treatment with the patients lifestyle.
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Behavioural methods
4 Increasing sense of control.
5 Prompts and reminders - using alarm
settings on a watch or telephone calls to
remind patients.
6 Contingency contract - goals and rewards
negotiated with health worker.
Behavioural methods
7 Modelling - patient can see other patients
successfully following their treatment.
 Major advantage is that patients can
become involved in their treatment (Turk
& Meichenbaum, 1991).