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AC1 (Izzy) > Week 7: Concordance/ Adolescent self management > Flashcards

Week 7: Concordance/ Adolescent self management Flashcards

1
Q

Define concordance

A

A negotiated, shared agreement between clinician and patient concerning treatment regime (s), outcomes and behaviours; a more cooperative relationship than those based on issues of compliance and non compliance.

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2
Q

Define compliance

A

The fufilment by the patient of the healthcare professional’s recommended course of treatment.

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3
Q

Define adherence

A

The extent to which a person’s behaviour - taking medication, following a diet, and or executing lifestyle changes corresponds with agreed recommendations from a health care provider.

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4
Q

How is concordance reached?

A
  • Concordance is reached through a therapeutic alliance and negotiation between the prescriber and patient.
  • The patient is encouraged to dicuss concernsa bout medications that have been prescribed and preference for tx, and participation in decision making
  • the health professional gives evidence based information to the patient and shares his or her clinical experience.
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5
Q

Give examples of therapeutic behaviours to be negotiated

A
  • seeking medical attention
  • taking medication app.
  • filling prescriptions
  • obtaining immunizations
  • attending follow up appt.
  • behavioural modification of personal hygiene
  • self management of asthma or diabetes
  • smoking
  • contraception
  • risky sexual behaviours
  • unhealthy diet
  • insufficient level of physical activity
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6
Q

What are the main effects of poor concordance?

A
  • Problems for treatment outcomes and direct clinical consequences
  • increases financial burden on society
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7
Q

How can poor concordance affect treatment outcomes?

A
  • poor concordance is directly associated with poor treatment outcomes in patients with diabetes, epilepsy, AIDS, asthma, tuberculosis, hypertension, and organ transplants
  • Poor concordance has an effect on long term conditions –> e.g. diabetes has many potential long term complications, it is vital concordance is embraced
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8
Q

describe the financial burden caused by poor concordance?

A
  • excess urgent care visits, hospitilisation and higher tx costs
  • poor concordance linked to 33-69% medication related hospital admissions in US and 25% hosp admissions in australia
  • Annual burden to U.S. = 100 billion
  • Annual burder to U.K of unplanned pregnancies = 135.5 million
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9
Q

What are the factors affecting concordance?

A
  • Patient centred
  • Therapy related
  • Social and economic
  • healthcare system
  • disease
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10
Q

Factors affecting concordance:

Patient centred aspects?

A
  • Demographic (age/ income etc)
  • psychological
  • patient prescriber relationship
  • health literacy (degree to which individuals have capacity to retain, process and understand medical advice).
  • patient knowledge
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11
Q

How does demographics influence concordance?

A
  • Age –>
    • better concordance as pts get older until disabilities occur
    • younger patients work commitments hamper concordance
    • adolescents have poor concordance –> rebellious behaviour and disagreement w parents/ authorities
  • Ethnicity, Gender and education –>
    • Equivocal results
    • except in adolescents with diabetes
  • Marriage –>
    • increases concordance (may be due to support from the spouse)
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12
Q

How can the psychological state of the pt affect concordance?

A
  • Psychological state of pt affects both:
    • patient attitude towards therapy
      • negative attitude towards therapy –> depression, anxiety, anger towards illness.
      • adolescents feel stigmatised and different to their peers.
    • patient beliefs and motivation
      • ideally patient is motivated to take the treatment if they believe it to be effective and patient believes illness poses threat
      • other end of spectrum; pt believes disease uncontrollable, fear dependence on treatment and fear tx will become ineffective.
      • may be religious beliefs and cultural beliefs –> e.g. malaysians fearing western medicine, supernatural beliefs in pakistan, tongans think illness is God’s will.
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13
Q

What aspects affect the patient prescriber relationship?

What aspects can go wrong?

How can we improve pt prescriber relationship?

A
  • Communication
  • Patient’s trust in prescriber
  • Empathy of prescriber towards patient

What goes wrong –> pts feel drs lack compassion for their problems, and multiple physicians involved in care

Improving care –> patients help design treatment plan, detailed explanation re disease and treatment, pts need to understand illness and therapy.

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14
Q

What aspects of health literacy are there?

A
  • being able to read
  • understanding what is read
  • remembering what is read
  • acting on information
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15
Q

How does knowledge affect concordance?

A

patients need knowledge of:

therapy and its role

lifestyle changes

clinics and their role

long term complications

However in adolescent compliance more knowledge is not always best –> there is an optimal level of knowledge.

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16
Q

What therapy related factors affect concordance?

A
  • route of administration –> oral best
  • treatment complexity –> dosing frequency not quantity
  • side effects
  • degree of behavioural change needed –> type ii diabetes
  • duration of treatment –> compliance high during acute illness, lowest during medium term illness and becomes higher with chronic illness
  • With medium term illness compliance declines from 3 months (87 % compliance) to 12 months (68% compliance).
17
Q

What social and economic factors affect concordance?

A
  • Time commitment for appointments
  • 1:10 US seniors cannot afford medication
  • Social support from family and friends
18
Q

How does the healthcare system affect concordance?

A

1) accessibility and availability –> waiting times, problems getting referred, quality of consultation

19
Q

How does disease affect concordance?

A
  • Concordance reduces with:
    • fluctuating / absent symptoms –> hypertension
    • severity –> adolescents better with mild asthma
  • Concordance improves with:
    • ​marked improvement of sx
    • percieved poor health status
20
Q

How can concordance be achieved in practice?

A
  • Doctors and pt are equals in partnership
  • Dr explains illness and explores patient beliefs
  • Dr describes treatment options so understandable
  • Pt and dr discuss beliefs about tx
  • pt makes informed decisions
  • pt controls choice and takes responsibility
21
Q

Challenges for the health service and concordance?

A

when multiple tx’s required

need to promote self management

depression is prevalent

22
Q

identify main health challenges in adolescence

A
  • Adolescence –> ranges from 10 -19 yrs of age
  • higher morbidity and mortality rates in adolescence than earlier childhood
  • during adolescence pts learn to manage onset of new conditions
  • long term self management of existing chronic conditions
23
Q

identify link between brain development and risk taking

A
  • Biological basis of adolescent risk taking behaviour:
    • observed behaviour e.g. risk taking
    • risk behaviours = those that potentially expose people to harm, or significant risk of harm which are associated with poor health or psychosocial outcomes
    • risk taking = normal part of adolescent behaviour
    • disparity in maturation between the limbic sx and prefrontal cortex during early to mid- adolescence
    • brain maturing at 25 yrs
    • developmentally app. exploratory behaviour
24
Q

when is long term self management initiated and why?

what tends to be a problem during the intro of long term self management?

A
  • long term self management is initiated during adolescence
  • there is a period of transition to self management with ups and downs along the way
  • self management behaviours initiatives at this time remain for life and therefore succesfful negotation of transition is essential
  • lack of concordance is notably a problem –> part of learning to self manage and fit in rather than deliberately destructive behaviour
25
Q

Why do young people find self management and concordance challenging?

A

self management requires:

1) working towards independence and autonomy
2) new relationships with peers, family and clinicians
3) new environments and activities

26
Q

how can different conditions affect the degree to which young people manage that condition in line with medical advice?

A

degree to which young people manage their condition in line with clinical advice varies by:

1) age
2) gender
3) family context
4) socioeconomic position

some barriers are similar across conditions

some barriers are condition or treatment specific

27
Q

•Explain why self-managing Type 1 diabetes can be challenging in adolescence

A
  • diabetic control often deteriorates in adolescence
  • mean HbA1C levels increase w age, at all ages mean levels slightly higher in females than in males
  • diabetic control among young people w type 1 diabetes is poorer than in other high income countries
  • management regimes can be difficult and demanding
28
Q

•State reasons given by children and young people with diabetes for poorer concordance with treatment

A

self monitoring can be inconvenient and disruptive (social activities take priority)

feeling of being “controlled” by parents, school staff, clinicians

management regimens can make it difficult to “fit in” –> use of normalisation strategies, social relationships are a key factor in self management.

29
Q

•Explain the how gender can affect self management

Girls

A
  • gender refers to the social/ cultural meanings assigned to being male or female
  • gender impacts on meanings and management of diabetes in adolescne
  • Girls:
    • may be more likely to incorporate diabetes into their identity
    • more open about their condition with friends
    • expectation that able to self care assocaited with less parental monitoring
    • more freq reported “secret” non adherence –> associated with less monitoring
    • consequential feelings of guilt and self blame
    • can feel pressures of taking over self care
30
Q

•Explain the how gender can affect self management : Boys

A
  • Boys may perceive diabetes to be more of a threat to their gender identity (masculine status) than girls
  • less open about condition or managed condition in public – > passing strategy (not disclosing hidden stigma felt about having DB).
  • may be less independent in management –> mothers more likely to be invovled in management of diabetes
31
Q

What do young people w chronic conditions want?

A
  • treated as a person, not differently
  • encouragement, support, understanding
  • no enforcement, options given
  • expertise given

AC1 (Izzy) (48 decks)

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