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Lecture
for 4th year medical students by Professor Omar Hasan Kasule
Learning
objectives
·
Explore factors of compliance
·
Key words: chronic disease,
treatment compliance
ISSUES TO
CONSIDER
·
Autonomy: Coercion
·
Confidentiality: monitoring
·
Compliance: barriers, enhancers,
coping strategies
CASE SCENARIO 1:
·
The primary care physician
refused to see a chronic bronchitis patient he had been advising to cut down on
smoking.
·
The patient came to the clinic
smoking. The doctor told him to go away saying he will not waste his time on a
disobedient patient.
CASE SCENARIO 2:
·
A 55-year old hypertensive
patient on treatment refused to take any more medication because it caused him
erectile dysfunction.
·
The doctor explained to him that
he risked getting a stroke and suggested providing him with Viagra at the
hospital’s expense.
CASE SCENARIO 3:
·
A primary care physician insists
that the patient he considers incompliant should come to the clinic every
morning to take his pills while the doctor is watching
CASE SCENARIO 4:
·
A surgeon who suspects the
patient does not carry out scheduled exercises at home asks the patient to use
his handphone to send live images of exercising to the clinic
CASE SCENARIO 5a:
·
Nathan is a healthy man in
his early 40s. He works out regularly and does not smoke.
·
Dr. Wechsler is speaking to
Nathan in his office regarding the results of his annual physical.
"Nathan, your results are generally good except for your triglycerides and
cholesterol. They are off the chart. For someone who is so conscious of how to
stay healthy, you have ignored everything we know about elevated lipids."
CASE SCENARIO 5b
·
"Listen, doc,"
Nathan says, smiling. "Everything else looks good, right? No one ever died
from high cholesterol. I wouldn't worry about it."
·
Dr. Wechsler hands Nathan a
brochure that appears to discuss the significance of elevated lipids and says,
"Read this, Nathan. Perhaps you will gain an appropriate perspective from
it. Triglycerides are a form of fat in the bloodstream. People with high
triglycerides often have high cholesterol, which puts you at risk for make some
major changes in your diet and perhaps take a lipid-lowering agent. You should
remove red meat and foods high in sugar from your diet."
CASE SCENARIO 5c
·
Nathan looks at the doctor
with dismay, thinking about how much he loves Monday’s steak night at his
favorite restaurant.
·
The doctor provides Nathan
with a diet sheet and a prescription for a lipid-lowering agent after discussing
the changes that need to be made.
·
Nathan thanks the doctor
and leaves the office. When he gets into his car, Nathan throws the diet sheet
in the back seat, saying to himself, “I got one life; I’m not giving up steak
night.”
Mo Med.
2011 Nov-Dec;108(6):439-42.
·
A
variety of authors have suggested that children and adolescents are at risk for
serious adverse health outcomes because of a lack of compliance with medication
regimens. A lack of compliance includes taking less or more medication than
prescribed, and taking medication at the wrong times.
·
One
study that examined the medication compliance of 81 students who were 10 years
of age or older, and were enrolled in a school-based health center, determined
that only 45 students (56%) filled the prescription given to them by the
doctor.
·
Of
those students who filled the prescription, 76% reported that they always took
the medication on time, 22% reported forgetting to take the medication some of
the time and 2% reported never taking the medication.
·
The
great majority of study subjects reported forgetfulness as the main reason for
skipping drug doses.
·
There
was no difference in medication compliance between the general patient
population and patients receiving antihypertensive therapy and there was no
correlation between medication compliance and age.
·
Healthy
lifestyle behaviours and perception of self-efficacy regarding medication
adherence showed improvement after education sessions.
·
Systolic
and diastolic blood pressures of subjects showed a significant decrease in
those who got education compared with those of the control group
·
Patient
education medication adherence alone and in combination with healthy lifestyle
behaviour teaching is an effective tool for blood pressure reduction in the
hypertensive population in primary health care settings.
·
The
inhaled corticosteroids adherence of the patients with a family asthma medical
history were significantly higher (p=0.034) than those without this medical
history.
·
The
ratio of the asthma-related emergency department visits of the patients with a
family asthma medical history were significantly lower (p=0.043) than those
without this medical history.
·
A
significant correlation between the mean patients' adherence and the asthma
symptom severity at the end of surveillance was found (p=0.010),
·
Logistic
regression analysis indicated that comorbid chronic disease, self-driving,
seizure after a missed dose, and self-efficacy were significantly associated
with medication compliance.
·
These
data suggest that health care providers of patients with epilepsy pay more
attention to treatment of comorbid chronic diseases, the safety issues of
self-driving, seizures occurring after missed doses, and awareness of
self-efficacy.
·
There
was a compliance rate of 79.6% with the administration of sublingual
immunotherapy. Factors associated with compliance were severe nasal, eye and
airways symptoms, and strong impairment in social and work life.
·
Compliance
with the intake of H1-antihistamines was 98%.
·
Patients
with a concomitant disease, especially with a bronchialasthma or a psychiatric
disorder had higher odds for being non-compliant.
·
Patient
followup compliance decreased over time [6 months (82%), 1 year (78%), 2 year
(37%)].
·
Attendance
at 6-month followup was found to be a significant positive predictor for 1-year
followup. Using a multivariate model,
·
obesity
was found to be a negative predictor for 2-year followup,
·
compliance
with 6-month and 1-year followup was found to be a positive predictor for
2-year followup. The data shows that current patient-dependent followup
protocols are ineffective beyond one year, with only 37% of patients returning
for their 2-year visit. Inclusion of a 6-month visit may improve 1-year
followup, but 2-year followup remained low.
·
Patients
with dyspepsia in rural Greece tend to avoid upper gastrointestinal endoscopy
·
Causes
of patients' refusal: their beliefs towards endoscopy and their personal
capability to cope with it.
Can J Cardiovasc Nurs. 2009;19(1):7-12.
·
Despite
the availability of effective treatment, more than half of patients treated for
hypertension drop out of care entirely within a year of diagnosis.
·
Fifty
per cent of patients who remain under medical supervision take only 80% of
their prescribed medications.
·
75%
of patients with a diagnosis of hypertension do not achieve optimum blood
pressure control due to poor adherence to anti-hypertensive treatment.