Adherence/Compliance Archetype

Clinical
#1

Hi Everyone!

Happy New Year from Jamaica!
We hope it has been treating you well so far

We have been thinking about creating an Adherence Archetype that could be used to cover a variety of adherence conditions, and wanted to find out if anyone else in the community had been doing work on anything similar.

For our immediate use case scenarios, we are thinking about Medication, Nutrition and Exercise compliance, particularly in reference to Non Communicable Disease management.

We are thinking about also capturing reasons for lack of compliance/adherence, Behavioural? Social/Economic? etc.

We’d also started taking a look at the Morisky Medication Adherence Scale.

Any thoughts?

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#2

Hi Keisha,

The ‘Readiness for change’ archetype might also be useful to you re behaviour change - https://ckm.openehr.org/ckm/archetypes/1013.1.20

Looking forward to maybe seeing a MMAS OBS soon :wink:. Please share

Regards

Heather

#3

Hi Keisha,

Best wishes to you as well. It’s probably not exactly what you need, but you could have a look at the Goal archetype. It has an element for goal outcome. Where you could list the result and probably reasons why it fell short, like suboptimal therapy adherence.

I’m interested to hear about your decisions.

#4

Hi @KBarwise

Adherence is in my wishlist to, and I already start to gathering some relevant data points. I don´t want the model to be binded to any scale, because there are so many, and there are always legal issues in use them. So I was thinking to level up in the abstract representation, allowing the use for different cases like: treatment, medication, self-monitoring, exercise etc. Here my inicial draft.

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#5

Thank you @heatherleslie and @joostholslag we will check out those suggestions and keep you updated.

#6

Thaks Nunio- interesting.

I initially thought that Goal did not quite work as-is but I wonder if adding an Adherence to the Goal archetype might work for simplere use cases.

Readiness for change is also interesting but does not feel quite right to me

@KBarwise - can you give us more detail ? screenshot of a form, to show us what your requirement looks like ?

Don’t you just love this community!!!

Ian

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#7

Well, I do not like the term adherence. I prefer self-management behavior because that’s what we want to measure. An intentional decision not to perform some activity is more proximal to adherence definition, and frequently, patient do not perform these activities because lack of Knowledge. But in terms of using in the goal archetype, seems a good idea, when we want to relate to existent goals.

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#8

I like the concept of Self-management. It’s sounds more empowering for the patient.

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#9

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@ct.delisser is also a part of our team from the MOHW Jamaica

Thanks @ian.mcnicoll
This is what the form that we are working from looks like, but we also thought it would be useful to capture what is preventing patients from appropriate self management as well so that appropriate solutions could also be explored where applicable or to inform how we can further support the patient.

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#10

Hi Keisha,

It seems from this form that this is about Diabetes treatment adherence. Is that a correct assumption?

This form definitely should be represented as a template, made up of multiple archetypes. And I suggest there is a simple pattern about a clinician’s assessment about whether the individual is following a treatment plan.

This could be about individual tasks or activities that might have been identified in the goal archetype (eg diet, exercise etc), taking medication (no matter what the medication or form). It could be quite simple but broadly applicable, and be used alongside validated instruments like the MMAS

@nuno.abreu @ct.delisser I think self-management is a strategy/process/philosophy of patient/individual/consumer empowerment and accountability which is ideal, especially in management of chronic disease.

But there is a need for assessment and, I hesitate to use the word ‘judgement’ about adherence to the care plan or goals etc, where a clinician says the empowerment and accountability is working, or not and identifying a need for ‘Plan B’.

I pointed you to the ‘Reason for change’ because that is about identifying where patients are in the Stages of Change model, but more importantly in this use case, the barriers to adherence (rather than change) and positive/negative aspects of adherence or non-adherence etc. I think we could utilise some of the modelling pattern here to inform modelling adherence.

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#11

Yes this section of the form would be a part of a larger template and was created to record data specifically about Diabetic and Hypertensive patients but we felt that there could be wider use for other treatment scenarios which was why we questioned if an archetype could be useful.

Ultimately yes, the importance of tracking this is to be able to provide additional support and recommendations to our patients and constantly modifying that to get them on their way to better health!

Thank you so much for your feedback @heatherleslie and this discussion, definitely gives us more to think about.

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#12

Totally agree - if we can identify some generic requirements about adherence and barriers/personalised pros & cons that could inform a care plan, it could be very valuable.

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