Adherence to Medical Regime Mind Map

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  • Adherence to Medical Regime
    • Measures of Adherence
      • Lowe and Raynor
        • Self Report
      • Becker
        • Self Report
        • Blood Validity Test
      • Lustman et al
        • Physiological Method
      • Chung and Naya
        • Mechanical Mehod
      • Therapeutic Outcomes
        • Looking at whether drug has been effective
        • Most common
          • Not always the case that strict adherence = positive outcome
      • Physiological Method
        • Not always possible with all conditions
      • Self Report
        • Social Desirability and Demand Characteristics possible
    • Reasons for Non-adherence
      • Rational Non-adherence
        • Costs of adhering outweigh benefits
        • Examples
          • Practical Barriers
            • Social Difficulties
            • Cost
          • Unpleasant side effects
          • Treatment not working
        • Believe it's not in  their best interests to adhere
      • Cowpe's Chip Pan Fire Study
        • Self-Efficacy Beliefs
        • Extent to which we believe we are capable
      • Becker's Health Belief Model
        • Cost-Benefit Analysis
        • Perceived Seriousness and vulnerablity
      • Dannenberg
        • Low adherence despite a law in place
      • Bulpitt et al
        • Study on males with hypertension
        • Long term linked with heart disease/strokes but asymptomatic in short-term
          • Side effects such as erectile dysfunction
            • Therefore males rationally decide NOT to take meds
        • Cost of side effects outweigh long term benefits of lower blood pressure
        • Qualitative approach providing insight
      • Lowe and Raynor
        • Assess extent to which intentional non-adherence is present in elderly patients
        • 161 patients from general practise
          • 76 years old
          • 33% Male
          • 71% living alone
        • Interviewed using structured questionnaire at home
          • Responses compared to medical records
            • Questioned about discrepancies
        • Results
          • 28 cases = admin error
          • 3 cases = patient confusion
          • 55 cases = rational decision to alter meds
        • Conclusions
          • Elderly patients made a rational decision est on cost-benefit analysis in 1/3 of cases
          • Most frequently side effects or adjustment according to symptoms
    • Improving adherence
      • Behaviorist Approach
        • Methods
          • Modelling
          • Direct Reinforcement
          • Contingency Contracts
            • Patients negociates contract with healthcare worker concerning goals and rewards for achievement
          • Feedback and Self-Monitoring
          • Punishment
      • Watt et al
      • Leys et al and Banyard
        • Found patients forget most info given by doctors
        • If doctors trained to structure given info and write down instructions adherence rates can be improved (Particularly in the elderly)
      • Simons et al
        • Suggests reasons for not taking statins are largely irrational
          • May be open to intervention to improve adherence rates
      • Health Belief Model
        • Demographic Variables such as Gender are useful

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