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PROMOTING MEDICATION
COMPLIANCE FOR PATIENTS
WITH DIABETES
Victoria Oladimeji (Ph.D., MA,
MBA, BA, RGN, RM)
Lecturer in Nursing With
Specialty in Health Promotion
City University St. Bartholomew
School of Nursing and Midwifery,
Philpot st White Chapel
London EC1 2EA
Tel: 020 7040 5887
Abstract
The effectiveness of treatment of a disease depends
mainly on two factors: the efficacy of the treatment
prescribed and the rate of compliance of the patient
with this treatment.
Non-compliance could lead to lack of response to
treatment or worsening of the existing medical and
nursing problems. It could also lead to unnecessary
lengthening of patient’s stay in hospital. In the current
atmosphere of cost-cutting and waste minimization,
hospital and ward managers are looking for ways of
improving the quality of care provision for patient in
order to ensure successful rehabilitation at home.
Improving medication compliance by patients is one
way of improving the quality of treatment regimes in
hospital as well as ensuring effective rehabilitation and
prevention of re-admission of patients to hospitals.
The aim of this poster is to explore ways of increasing
medication compliance for older adults in hospital
settings.
Introduction
Non-compliance with
medication can be
considered one of the
most serious problems
facing health care
(Urquhart, 1992; Wright
1993).
This paper explores ways
of improving medication
compliance amongst
older adults in hospital
settings. Strategy for
improving medication
compliance is offered.
The effectiveness of treatment of any disease
including diabetes depends mainly on two
factors:
1.
the efficacy of the treatment
prescribed.
2.
the rate of compliance of the patient
with this treatment (Vallis et al 2003).
Non-compliance, in diabetes, occur more
frequently when patients:
– are older (Weingarten and, Cannon
1991).
– receive more medication (Stuart and
Coulson 1993) and or experience side
effects
– have to take their medicines regularly,
and over a long period of time(
Nicholas et al 1995)
Literature Review
Various studies have shown a relationship
between the number of doses to be taken
and compliance, but others provide no
evidence for such a relationship. The results
of these studies are not fully consistent, but
they provide in general a view of a higher
compliance with once- or twice-daily doses
than with three- or once-daily doses
(Nicholas et al 1995).
Vallis et. al (2003) found that willingness to
change in relation to medication compliance
are correlated with sex, age, marital status,
BMI, diabetes education, quality of life, and
social support.
Lack of knowledge or understanding either of
the illness or of the medications prescribed to
treat it can lead to non-compliance of
medication regime.
Non -compliance depends on:
– Complexity of the treatment.
– Length of time during which the patient
has to follow advice.
– Whether the treatment is seen as
potentially life saving.
– Severity of the illness as viewed by the
patient.
– Patients’ feeling of improved health
status (Cargill 1992; Vallis 2003)
Cargill (1992) found that patients took
insufficient medication because they felt
they had been over-prescribed. He also
identified patient-nurse relationship that
was built on trust as influencing factor.
Becker’s Health Belief Model focusing on
the need to motivate and educate the
patient in order to enable them to make
informed decisions should be considered.
According to Becker (1974)
the rationale behind the
Health Belief Model is that
the individual’s decision to
take action will be based
on certain criteria such as:
– Susceptibility- the
individuals’ belief
that the disease will
occur or re-occur.
– Severity of the risk or
illness.
– The benefits to be
gained from
complying with
therapy.
– Cues to action - i.e.
stimuli which trigger
appropriate health
behaviour.
Diverse factors- Demographic,
cultural, social and personality
factors that may influence
health behaviour.
These link into the patient’s social and family
circumstances. Other factors include:
Inadequate explanations of medications.
Possible side effects.
– Presentation - child proof containers
and blister packs are difficult
– Manipulate particularly for the older
person.
– Small print difficult to read.
– Altered general mental functioning in
some older people MacDonald (Vallis,
2003).
Knowledge and
understanding of illness
Knowledge of the
illness and the
desired effect of
therapy facilitates
compliance (Vallis
2003)
Vallis suggested
that it is not just
knowledge that is
important but
understanding
and application of
the knowledge.
Level of communication.
Level of motivation &
commitment.
If patient has failed to comply with regime in
the past, find out why and consider other
options.
Availability of resources e.g time /personnel/
environment.
According to Mager (1962) learning involves
3 domains:
1. Cognitive (information and
understanding)
2. Affective (attitudes and feelings)
3. Psychomotor (skills)
Patient education needs to incorporate all
three aspects.
Factors to be consider in
planning and implementing
education for medication
compliance:
– Number, content, timing, and pace of
sessions,
– Resources
– Feedback
– Involvement of the pharmacist
– Written information
– Flexibility
– Post-discharge teaching
Conclusion
Medication compliance for
patients with diabetes is
one way of improving
glycaemic control and
minimizing some of the
complications of diabetes.
Application of Becker’s
Health Belief Model
enables the health
professional to assess the
needs, motivate and
educate the patient in order
to enable them to make
informed decisions.
References
1. Becker M. H. (1974) - The Health belief model and sick
role behaviour, Health education monographs. winter.
2. Cargill J. M. (1992) - Medication compliance in elderly
people. Influencing variables and interventions. Journal of
advanced of Nursing. 17. 422-426.
3. Mager R. (1962) Preparing instructional objectives,
California: Fearon.
4. Nicholas WC, Fisher RG, Stevenson RA, Bass JD: Single
daily dose of methimazole compared to every 8 h
propylthiouracil in the treatment of hyperthyroidism. South
Med J 88:973-976, 1995
5. Stuart B, Coulson NE: Dynamic aspects of prescription
drug use in an elderly population. Health Res 28:237-264,
1993
6. Urquhart J: Ascertaining how much compliance is enough
with outpatient antibiotic regimens. Postgrad Med J 68
(Suppl. 3): S49-S59, 1992
7. Vallis M, Ruggiero L, Green G, Jones H, Zinman B, Rossi
S, Edwards L, Rossi JS, Prochaska JO: Stages of change
for healthy eating in diabetes: relation to demographic,
eating-related, health care utilization, and psychosocial
factors. Diabetes Care 26:1468-1474, 2003
8. Wright EC: Non-compliance: or how many aunts has
Matilda? Lancet 342:909-913, 1993
9. Weingarten MA, Cannon BS: Age as a major factor
affecting adherence to medication for hypertension in a
general practice population. Fam Practice 5:294-296, 1988