Adherence in Dentistry
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What is adherence?
Patient’s ability and willingness to follow recommended health practices including maintaining these
How high is nonadherence for medicines?
30-50%
Name 2 umbrella terms of nonadherence?
• Unintentional nonadherence 2. Intelligent nonadherence
Name 3 types of nonadherence
• Fulfilment • Non-Persistence • Non-Conforming
What is fulfilment in terms of nonadherence?
Prescription is never filled or initiated by the patient
What is non-persistence in terms of nonadherence?
A patient decided to stop taking medication on their own, usually due to miscommunication of the therapeutic plan
What is non-conforming in terms of nonadherence?
Medication is not taken as prescribed e.g. skipping doses, taking incorrect doses
Name 5 categories of risk factors related to nonadherence
• Social and Economic • Health Care System • Condition Related • Therapy Related • Patient Related
Describe 4 components of social and economic risk factors related to nonadherence
• Limited language proficiency • Low health literacy • Homelessness • Medication cost / Lack of insurance
Describe 4 components of health care system risk factors related to nonadherence
• Patient-provider relationship • Long wait times • Lack of care continuity • Restricted formularies
Describe 4 components of condition related risk factors related to nonadherence
• Lack of symptoms • Severity of symptoms • Depression • Psychotic disorders
Describe 4 components of therapy related risk factors related to nonadherence
• Complexity of regimen • Duration of therapy • Frequent changes • Actual or perceived side effects
Describe 4 components of patient related risk factors related to nonadherence
• Visual, hearing or cognitive impairment • Knowledge about disease • Perceived susceptibility to disease • Motivation and confidence
Describe Ley’s Model of Compliance
• Understanding and memory lead to satisfaction • Understanding, memory and satisfaction all lead to compliance • Compliance shifts to adherence which shifts to concordance
Describe how health literacy can be a barrier to adherence
• Mismatch between patients’ health literacy skills and informational demands by provider • Many patients have difficulty understanding information • Patients forget up to 80% of what physicians tell them
Describe the effects of low health literacy
• Lower knowledge, poor adherence, fewer preventative services and increased cost • Barrier to effective prevention and treatment
Name 3 factors relating to the dentist which can influence nonadherence
• Communication skills • Personal beliefs • Personal knowledge of patient
Name 4 problems associated with diabetes
• Hypoglycaemia • Circulation problems • Heart problems • Vision problems
Name 4 reasons why a person with diabetes may not adhere to doctor’s advice
• Embarrassment of testing and injecting in public • Lack of family / social support • Restriction on normal daily routine • Feeling different by following an alternative diet
Name 1 reason why there may be poor patient adherence in dentistry in terms of reward
Patients are asked to act to avoid disease in the future and immediate benefit can be hard to see
Describe 4 ways which nonadherence in dentistry can have health and financial implications
• Missing appointments • Failing to follow oral health advice • Failing to change daily routine • Not wearing appliances
Name 5 parental views on factors influencing tooth brushing in children from Duijster D et al., study in 2015
• Parenting strategies • Parental monitoring and supervision • Parental knowledge • Perceived importance • Tooth brushing routines
Name 5 parental views on factors influencing children’s consumption of sugary foods and drinks from Duijster D et al., study in 2015
• Affordability of food • Commercials and television • Social environment • Dietary routines • Parental control on diet at home
How does adherence relate to treatment of periodontal disease?
• Treatment is based around effective self care • Success dependent on information and motivation • Behaviour change required