Health eme eme

• Compliance


  The extent to which a person's behavior coincides with the medical advice given. Patient is passive and just follows the doctor's advice.
• Adherence


  The extent to which the patient's behavior matches agreed recommendations from the prescriber. Patient is active and involved in the regimen.
• Concordance


  An agreement reached after negotiation between a patient and health care professional that respects the beliefs and wishes of the patient in determining whether, when and how medicines are to be taken. There is deep communication, mutual understanding and decision-making with the patient and the physician regarding the regimen.
• The exact rate of adherence to medication regimens varies from study to study. However, regardless of definition and measurement, adherence rates are well below 100%. The consensus is that adherence rates for long-term therapies tend to be about 50%.
• Methods to measure adherence

  • Indirect methods (Subjective)
  • Direct methods (Objective)
• Indirect methods


  Interview the patient or caregiver to know the factors of being non-adherent
• Direct methods


  Use biomarkers or laboratory testing
• Most nonadherences have negative effects on patient health which, in turn, can result in increased emergency room and physician visits, hospitalizations, disability, premature death, and decreased productivity in the workplace.
• Reasons for poor or nonadherence

  • Patients
  • Healthcare providers
  • Healthcare delivery system
• Unintentional nonadherence


  Forgot to take the medicine due to some reasons (e.g., being busy)
• Intentional nonadherence


  Skip doses of a medication due to an uncomfortable side effect or because it should not be taken with alcohol
• False assumptions about patient understanding and medication adherence

  • Physicians have already discussed the medications
  • Patients understand all information provided
  • If patients understand what is required, they will be able to take the medication correctly
  • When patients do not take their medications correctly, they "don't care", "aren't motivated", "lack intelligence", or "can't remember"
  • Once patients start taking their medications correctly, they will continue to do so in the future
  • Physicians routinely monitor patient medication use
  • If patients are having problems, they will ask direct questions or volunteer information
• Techniques to improve patient understanding

  • Emphasize key points
  • Give reasons for key advice
  • Give definite, concrete, explicit instructions
  • Provide key information at the beginning and end of the interaction
  • Supplement and reinforce spoken words with written instructions
  • Assessment of a patient's ability to read and understand key written instructions is required
  • End the encounter by taking feedback
• Techniques to establish new behaviors

  • Tailoring of regimens
  • Provide appropriate adherence aids
  • Suggest ways to self-monitor
  • Monitor medication use
  • Make proper referrals
• Techniques to facilitate behavior change

  • Establish a new habit
  • Change old habits
  • Stop existing habits
• Components of motivation to change

  • Willingness
  • Perceived ability
  • Readiness
• Empathic understanding


  A core component that facilitates the patient's own problem-solving ability and frees patients from the fear that they are being judged because of their behavior.
• Stages of change


  • Precontemplation
  • Contemplation
  • Preparation/Determination
  • Action/Willpower
  • Maintenance
  • Relapse
• Interventions for precontemplation stage

  • Raise awareness of problem
  • Provide information
  • Convey empathy
  • Encourage thinking about
  • Express willingness to help
  • Avoid arguing
• Techniques to motivate patients to change

  • Express empathy
  • Develop discrepancy
  • Roll with resistance
  • Support self-efficacy
  • Elicit and reinforce "change talk"