Adherence

Consequences of Health Professional Nonadherence

-Ambivalence Example: Nurse feels he/she did all could -Misinterpretation Example: Nurse does not fully assess/understand client rationale(s) -Avoidance Example: Nurse fails to seek/make alternate plan based on evaluation -Decisional conflict Example: Ethical/moral conflicts or dilemmas? -Empathy Example: Nurse understands client financial constraints. Should nurse further advocate???

Consequences of Health Care System Nonadherence

-Increased cost Why? -Increased use of health care services What are /might be the overall healthcare ramifications?

Consequences of Patient-Related Nonadherence

-Increased mortality and morbidity rates Example: Patient does not take medications prescribed for asthma, he has an attack and dies. -Conflict with staff, family, or providers. Example: Family member yells at the patient about not taking their medication like they are supposed to. -Attributional uncertainty Example: Patient's may be uncertain of the correct course of action in treating their disease process and are non-adherent. -Embarrassment Example: Patient could not afford his medication and does not tell his/her provider due to the embarrassment of not having the money. -Changes in the quality of life Example. Patient may develop worsening dementia and can no longer care for themselves and therefore cannot remember to take their medications,.

Scope of Adherence definition

-The continuum of a patient's intentional or rational decision to stop the medication or change the dose or frequency of the medication.

Dimensions of Adherence

Adherence: measure of acceptance -Compliance: Measure of conformance -Persistence: Measure of continuation -Concordance: Measure of mutual agreement

Key Terms

Compliance Concordance Obedience Observance Acceptance Cooperation Mutuality Persistence Therapeutic alliance

Define Compliance

Compliance behavior is "the action taken on the basis of professional advice to promote wellness, recovery, and rehabilitation."

Consequences of Nonadherence

Consequences of nonadherence fall into three areas: -Patient related -Health professional-related -Health care system-related

Scope of Adherence

Non-adherence: Complete omission---> Partial adherence: (Intentional) Adjusting dose/frequency (increase or decrease)---> Partial adherence: (Non-intentional) Non-purposefully forgets/misses neglects---> Total adherence

Interdisciplinary Lens of Adherence

Nursing- What is nursing focus? Mental Health-Why would Mental Health be a part of Plan of Care? Medicine- How can Primary Providers be mutually involved? Pharmacy-What are pharmaceutical responsibilities/roles?

Define Adherence

Self-initiated action taken to promote wellness, recovery, and rehabilitation

Three Elements of Adherence

The behavior of adherence is separated into three elements of adherence: Compliance Persistence Concordance

Health Belief Model

The hypothesis is that health behavior is affected by the extent a patient (or caregiver) perceive: Perceived susceptibility Perceived severity Perceived benefits Perceived barriers