Adherence

•Compliance
denote a relationship in which the patient has a passive role and is expected to follow the doctor’s orders

•Adherence
patient asking about the treatment to doctor, before follow the doctor’s orders.

•Concordance
denote the degree to which the patient and health practitioner agree about the nature of the illness and need for treatment

 

Five interacting dimensions affect adherence

1.Social and economic Factors

  - low level education

  - lack of effective social support networks

  -  long distance from treatment center

  -  high cost of transport

  -  high cost of medication

2.Health Care Team and System-related Factors

  -  Poor medication distribution system

  -  Lack of knowledge and training for health care providers on managing chronic diseases

  -  Short consultation

  -  Weak capacity of the system to educated patients and provide follow-up

3.Conditional-related Factors

  -  Related severity of symptom

  -  Level of disability (physical,mpsychological, social and vocational)

  -  Rate of progression and severity of the disease

  - The availability of effective treatments

4. Therapy-related Factors

  -  Related to the complexity of the   medical regimen

  -  Duration of treatment

  -  Previous treatment failures

  -  Frequent changes in treatment

5. Patient-relate Factors

  -  Forgetfulness

  -  Psychosocial stress

  -  Low motivation

  -  Misunderstanding and  non-acceptance of the disease              

  -  Hopelessness and negative feelings

  -  Fear of dependence

 Role of Pharmacist:

•Giving inform to the patient of the benefits and importance of compliance to achieve treatment success

•Giving confidence to the patient to the drug's effectiveness in healing

Reference :

Gard, P.R. 200. A Behavioural Approach to Pharmacy Practice. Oxford: Blackwell Publishing

WHO. 2003. Adherence to Long-Term Therapies: Evidence for Action

Social Pharmacy

SELF REGULATORY MODEL

There are three stages in this model:

1. Interpretation of health threat – cognitive representation such as: symptoms, social messages, cues and possible consequences.
2. An action plan or coping strategy – seeking medical attention, self-prescribing, discussing with other, avoidance ie. denial or wishing away
3. The final stage is the appraisal stage – an evaluation of the success of coping strategies or actions, and reflecting on the need for modifications
The self-regulation comes from the individuals attempts to maintain the status quo and return to the ‘normal’ state of health.

Where this model differs, however, is in its description of the interaction between cognitions, motivation, and behavior. Self-regulation refers to efforts to lessen the discrepancy between current status (i.e., ill) and a future goal state (i.e., less ill or not ill). The self-regulatory model breaks self-regulation down into three stages: representation of the illness, which may be activated by internal cues (e.g., symptoms) or external cues (e.g., information); development and implementation of a plan to cope with the illness; and evaluation of the coping mechanism (see Fig. 2.4). These stages serve to create a dynamic feedback loop; that is, a person moves from stage to stage, both forward and backward. For example, one could determine that one has a headache (representation), decide to ignore it (cope), realize that it is not going away on its own (evaluate), take medication (reenter coping stage), and feel better (reevaluate). As demonstrated in this example, the decision about whether to adhere is conceptualized as one of a number of possible procedures for coping with an illness threat.

The cognitive component includes beliefs about the threat of illness, which give rise to coping mechanisms and an evaluation of those mechanisms for dealing with the threat. The affective component includes feelings about the illness, such as fear or distress, which give rise to coping mechanisms and an evaluation of those mechanisms for regulating emotion.

Cognitive representation. These form a representation of what the threat means. This can be thought of as a mental map or model of the illness and comprises five components.

A woman experiencing the symptoms of hay fever for the first time one morning (for

example, sneezing and blocked up nose) may hold the following initial representations:

Identity: 'It's a summer cold'.

Cause: 'I must have caught a cold from someone in the office last week'.

Time-line: 'It'll probably last about a week'.

Consequences: 'My performance at work may not be at its best next week'.

Cure-Control: ''Taking plenty of vitatmin C will help and using a menthol inhalant'.

Coping procedure: Based upon these initial representations formed in response to the symptoms experienced, her coping strategy might be to eat plenty of fruit and taking something out of the medicine cabinet at home to 'unblock' her nose.

Appraisal: Later that afternoon she would not have expected the cold to be better due to increasing vitamin C intake, but she would have expected the menthol inhaler to have some effect. She doesn't know of anyone else who has a cold, but now her eyes are very red and are streaming.

HEALTH BELIEF MODEL

Everyone have different demographic variable and psychological characteristic.

Both of them will result different action.

Health belief model predicts that action or behaviorinfluenced by perceived susceptibility, severity, benefits, and barriers. Perceived susceptibility is one’s subjectives perception of the risk of contracting a condition.

Perceived severity is feelings concerning the seriousness of contracting the seriousness of contracting an illness (or of leaving it untreated). Both of them called perceived threat.

Perceived benefits, or beliefs regarding the effectiveness of the various action to reduce the disease threat. (ex : screening will detect problems at early stage)

Perceived barriers is the potential negative aspects of a particular health action that inhibit recommended behaviour (ex : difficulty in finding time to attend screening).

Cues to action is a stimulus to trigger the decision making process.