Therapeutic adherence - from prescription to behavior adherence

Code:

OPT155

Acronym:

ADETER

Keywords
Classification	Keyword
OFICIAL	Medicine

Instance: 2023/2024 - 2S

Active?	Yes
Responsible unit:	Departamento de Biomedicina
Course/CS Responsible:	Integrated Master in Medicine

Cycles of Study/Courses

Acronym	No. of Students	Study Plan	Curricular Years	Credits UCN	Credits ECTS	Contact hours	Total Time
MIMED	0	Plano Oficial 2021	5	-	2	19	54

Teaching language

Portuguese and english

Objectives

The curricular unit aims to introduce students to the field of Therapeutic Adherence, considering all the stakeholders involved in this problem, and allowing a clear comprehension of all dimensions of patient adherence, patient and condition related factors, treatment related factors, socioeconomic factors, health care system factors and health care professional factors. The curricular unit intends to increase the knowledge of General Therapeutics and Clinical Pharmacology, allowing for an integrative understanding of the factors inherent to the behavior of therapeutic adherence and the acquisition of specific competencies for current and future clinical practice in the various medicine areas.      

The unit will have four main objectives: to provide students with a comprehensive overview of the nature and extent of adherence based on evidence of non-adherence behavior challenges faced by patients; b) to enable students to identify opportunities for adherence that effectively contribute to the results of established therapeutics and reduce the use of health resources; c) to provide students with a structured approach for assessment of therapeutic adherence; d) to empower students on acquisition and training of consultations skills to support behavioral change in the direction of therapeutic adherence.  

Overall, the knowledge acquired in the curricular unit will serve to gain in-depth contact with a previously neglected area of health sciences, despite its recognition by WHO as one of the most common problems faced by the management of chronic diseases.  At the same time, it will provide medical students with competencies to develop a mediating role between clinical practice and therapeutic outcomes for the patient, which will go along with their future clinical activity.

Learning outcomes and competences

Working method

Presencial

Program

A – Therapeutic Adherence 

1. A new taxonomy
2. A public health problem
3. Nature, dimensions and impact

- Patients

- Doctor as a prescriber

- Health professionals 

- Industry

B – Non-therapeutic Adherence

1. Predictors and related factors
2. The importance and role of beliefs in disease and treatment –Leventhal’s Self-Regulatory Model
3. Non intentionality versus intentionality

C – The role of the pharmacist in Adherence to Therapeutics

1. The clinical dispensation of medicines and their rational usage
2. Pharmaceutical intervention in patient follow-up: review of therapy and therapeutic reconciliation
3. Custom dispensing systems and individualized preparation of therapeutics

Clinical Trials – D – The role of Industry in Therapeutic Adherence

1. Efficacy versus effectiveness of pharmacotherapy
2. Integration of practices for the therapeutic adherence improvement

E – Enhancement of therapeutic adherence

1. Therapeutic adherence assessment measures
2. Intervention models - SIMPLE; COM-B and Behaviour Change Wheel 
3. Motivational Interview – A structured approach to medication-related consultations

- Role-playing and effective consultations techniques

Mandatory literature

World Health Organization. ; Adherence to long-term therapies. Evidence for action. Geneva, Switzerland: World Health Organization., 2003
De Geest S, Zullig LL, Dunbar-Jacob J, Helmy R, Hughes DA, Wilson IB, Vrijens B.; ESPACOMP Medication Adherence Reporting Guideline (EMERGE). , Ann Intern Med.;169(1):30-35., 2018
Horne R, Chapman SC, Parham R, Freemantle N, Forbes A, Cooper V. ; Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework., PLoS One. Dec 2;8(12):80633., 2013
Horne R, Weinman J.; Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. , J Psychosom Res. Dec;47(6):555-67., 1999
Rollnick S, Butler CC, Kinnersley P, Gregory J, Mash B.; Competent novice: motivational interviewing., BMJ. Jun;340:1242-1245., 2010
Timmerman, L., Stronks, D. L., Groeneweg, J. G., & Huygen, F. J. ; ). Prevalence and determinants of medication non-adherence in chronic pain patients: a systematic review. , Acta Anaesthesiol Scand, 60(4), 416-431., 2016
Timmerman, L., Stronks, D. L., & Huygen, F; The design of a theory-based intervention to improve medication adherence in chronic pain patients. , Curr Med Res Opin, 33(7), 1293-1301, 2017
Bernard Vrijens, Sabina De Geest, Dyfrig A. Hughes, Kardas Przemyslaw, Jenny Demonceau, Todd Ruppar, Fabienne Dobbels, Emily Fargher, Valerie Morrison, Pawel Lewek, Michal Matyjaszczyk, Comfort Mshelia, Wendy Clyne, Jeffrey K. Aronson & J. Urquhart; A new taxonomy for describing and defining adherence to medications, British Journal of Clinical Pharmacology, 2012

Teaching methods and learning activities

The curricular unit will be based on 6 theoretical lectures, each of 2 hours, which will cover the syllabus contents from A to D, and 3 practical classes with 2 hours each, which will cover the syllabus E. The exam will be based on a two-parts: the first with multiple choice response will evaluate the knowledge acquired, and the second part with a practical sceneraio to identify the problem situation and solve it based on the learned models. Continuous assessment of class participation will be considered through practical training (role-play) of the acquired competences.

Evaluation Type

Distributed evaluation with final exam

Assessment Components

Designation	Weight (%)
Participação presencial	30,00
Exame	70,00
Total:	100,00

Amount of time allocated to each course unit

Designation	Time (hours)
Estudo autónomo	20,00
Frequência das aulas	19,00
Elaboração de projeto	15,00
Total:	54,00

Eligibility for exams

The curricular unit will be based on 5 theoretical lectures, each of 2 hours, which will cover the syllabus contents from A to D, and 2 practical classes with 2 hours each, which will cover the syllabus E. The exam will be based on a two-parts: the first with multiple choice response will evaluate the knowledge acquired, and the second part with a practical sceneraio to identify the problem situation and solve it based on the learned models. Continuous assessment of class participation will be considered through practical training (role-play) of the acquired competences.

Calculation formula of final grade

In summary, the formula will be: test + continuous evaluation (70/30)