Lecture 3: Health Psychology and Physical Illnesses I (Part 2) Dr. Antoinette Lee The University of Hong Kong

Adherence Adherence: “adopting behaviors or treatments that health care providers advice” Better term them compliance Non-Adherence is a big challenge for healthcare professionals Antoinette M. Lee, HKU Master in Behavioral Health Health Psychology Module, Spring 2005

Non-Adherence Includes Medication / Drug Non-drug treatment errors of omission taking of medicine for wrong reasons errors in dosage mistakes in timing taking additional medication not prescribed by physician total abandonment Non-drug treatment Lifestyle change Keeping appointments Monitoring Antoinette M. Lee, HKU Master in Behavioral Health Health Psychology Module, Spring 2005

Non-adherence 23-45% of patients do not take their medications as prescribed by their physicians Short-term antibiotic regimens: at least 1/3 non-adherence Appointments for Lifestyle changes (on one’s own): 50-80% non-adherence Dropping out of lifestyle change programs: 20-80% Antoinette M. Lee, HKU Master in Behavioral Health Health Psychology Module, Spring 2005

Non-Adherence McElnay et al. (1997) 15-63% among psychiatric patients 25-50% of general outpatients less common among inpatients Antoinette M. Lee, HKU Master in Behavioral Health Health Psychology Module, Spring 2005

Non-Adherence Davidson (1982) appointment-keeping - 50% taking short-term medication - 60%-80% taking long-term prophylaxis - 50% taking long-term drug to cure a disorder - 50% Antoinette M. Lee, HKU Master in Behavioral Health Health Psychology Module, Spring 2005

Methods of Assessing Adherence A highly difficult task with a lot of potential pitfalls May include: Patient’s self-report Family member’s report Pill counts Mechanical device to record time of opening a container Urine test Blood test Observation (for in-patients) Treatment outcome, relapse Charting actual follow-up appointments kept Are they taken in the correct amount, time, and manner? Antoinette M. Lee, HKU Master in Behavioral Health Health Psychology Module, Spring 2005

Case in Point: Depression Who are more likely to be non-adherent? Those in difficult social circumstances Those with mental disorders Compliance management among depressed patients a particularly difficult task!! Antoinette M. Lee, HKU Master in Behavioral Health Health Psychology Module, Spring 2005

Reasons for Non-Adherence Poor rapport Denial of illness or its severity Poor knowledge Forgetting Complicated or inconvenient dosage regimen Lengthy treatment regimen Disruption to life Intolerable side effects Perceived adverse effects of medication Adherence as product of “cost/risk – benefit analysis” Antoinette M. Lee, HKU Master in Behavioral Health Health Psychology Module, Spring 2005

Reasons for Non-Adherence Perceived lack of efficacy of treatment Perceived self-efficacy Esp. true for cases in which complex skill acquisition is needed Poor access to treatment / barriers (e.g. cost) “Creative / intelligent non-adherence” Modifying or supplementing a treatment regimens Fear of dependence Resists psychiatric diagnosis Improvement Depression Antoinette M. Lee, HKU Master in Behavioral Health Health Psychology Module, Spring 2005

Improving Compliance Doctor-Patient Relationship Good rapport Empathy Holistic approach: focus on the person, not the symptoms Professionalism Therapeutic alliance Constant follow-up Invite patients to ask questions Sensitive questioning Third-party reference Therapy tailoring Fitting in to patient’s lifestyle, schedule, preferences etc. Simplify / change dosing regimen; avoid polypharmacy if possible Antoinette M. Lee, HKU Master in Behavioral Health Health Psychology Module, Spring 2005

Improving Adherence Cognitive Strategies Explain The illness: causes, severity, treatability The drug’s mechanism of action Regimen Rationale for the regimen (e.g. antibiotic) Interaction with other drugs and consequences Side effects & support with dealing with side effects Gauge expectations and worries (perceived barriers) Elicit patient’s perceived negative effects of medication or lifestyle change Adherence as product of cost-benefit analysis Understand patient’s health beliefs and note discrepancies with clinician’s More likely to choose /adhere to a treatment option when it is framed attractively (40% chance of surviving versus 60% chance of not surviving) Antoinette M. Lee, HKU Master in Behavioral Health Health Psychology Module, Spring 2005

Improving Adherence Clear & simple instructions Clear and patient explanation, repetition Written Ask patient to repeat Demonstration of complex skills, followed by asking patient to perform the skill in front of you On follow-up: ask patients about how they actually took their medication, what difficulties they encountered Work out strategies to get around the problem with the patient NEVER tell patients what the drug is not Antoinette M. Lee, HKU Master in Behavioral Health Health Psychology Module, Spring 2005

Improving Adherence Behavioral Strategies Reinforcements Cues Tying in with regular features of patient’s daily routines Pill organizers Enlisting the help of significant other Antoinette M. Lee, HKU Master in Behavioral Health Health Psychology Module, Spring 2005