PS3833 Class 5: Sept 20 Tuesday

What is compliance? Predicting compliance Doctor variability Explaining variability the role of decision making Explaining variability the role of beliefs The consultation as an interaction

Open University Press, 2004

Haynes et al (1987): the extent to which the patients behaviours (in terms of taking medication, following diets or other lifestyle changes) coincides with medical or health advice

Open University Press, 2004

Ley (1981, 1989): cognitive hypothesis model (CHM): Understanding Satisfaction - compliance Memory

Open University Press, 2004

Primarily an educational model Doctor as expert transfers knowledge to lay person Patient as problem needs to be educated Doctor behaves as response to education and training

Open University Press, 2004

Doctors differ in their: - diagnosis of asthma - prescribing rates - measurement of blood pressure - treatment of diabetes

Could be variation in knowledge?

Open University Press, 2004

 Open University Press, 2004

 Open University Press, 2004

Access different information about symptoms Develop different hypotheses Access different attributes to confirm or refute hypotheses Have different degrees of confirmation bias Reach different management decision

Open University Press, 2004

Patients have beliefs which vary and predict their behaviour Doctors assume to have knowledge which is consistent But doctors also have individual beliefs Such beliefs influence hypothesis

Open University Press, 2004

Beliefs about: - causes of problem - probability of problem - seriousness of problem - treatability of problem - patient themselves - patients like this one

Open University Press, 2004

Health professionals mood Time of day Day of week Health professionals health behaviours Gender Age Weight

Open University Press, 2004

Patient has beliefs Doctor makes decisions based upon hypothesis testing Hypothesis is based upon health professionals beliefs Doctors communicate beliefs to patient

Open University Press, 2004

Communicating risk:
- McNeil et al (1982): patients offered surgery: increased chances of survival decreased chances of death patients chose surgery if it increased chances of survival - Misselbrook and Armstrong (2000): patients offered drug treatment for hypertension patients choice depended upon presentation of risk

Open University Press, 2004

Two individuals with two sets of beliefs Doctors and patients differ in their: - models of depression - models of obesity - beliefs about health - beliefs about role of doctor (Ogden et al, 1997-2000)

Open University Press, 2004

Traditional model of communication emphasises doctor as expert Doctor communicates knowledge based upon education and training Patient non compliance is patients problem But doctors show variability Relates to process of decision making Relates to doctors beliefs Consultation is interaction between two sets of beliefs

Open University Press, 2004