Transcript Adherence_studentppt..

This is Mark.
He has decided to
visit his doctor.
Oh doctor, I’ve got
such horrible smelly
feet!
Please help me!
Oh, goodness, I suppose you’d
better show me then.....
Blimey! You’ve
got athlete’s
foot, my boy.
Well, here’s
the deal......
Wash those
feet daily (not
necessarily in
a bidet...)
Dry
thoroughly
in between
those toes...
Cut toenails straight across....
Apply moisturiser...
Please limit your wearing of fashion shoes; you
need a good supportive shoe for good foot
health...
Wear a verruca sock
when swimming
Apply fungal cream twice
daily and continue for
two weeks after the
infection has
disappeared
You must apply the cream
to the rash and also to the
healthy 4 – 6 cm around
the rash.
Don’t forget!
TWO
MONTHS
LATER...
Well, how have
you got on?
OH NO!!
What do you mean, you
didn’t adhere to my medical
advice?
Whyever not?
In pairs, complete the starter worksheet.
You have about 10 minutes.
WHY IS ADHERENCE A PROBLEM?
Studies have suggested
that about half the
patients with chronic
illnesses such as diabetes
and hypertension (high
blood pressure) are noncompliant with their
regime. There is clearly a
large financial cost for this
in wasted drugs but also
potentially in poor health
outcomes.
A STUDY BY SACKETT (1976)
50% of patients in America did not take prescribed medications
according to the instructions and scheduled appointments for
treatment were missed 20-50% of the time.
Where compliance means going against well established habits and
going against strong motives (e.g. giving up smoking) compliance is
even worse.
Taylor (1990) suggested that 93% of patients fail to adhere to
some aspect of their treatment.
Sarafino (1994) argued that people adhere reasonably closely
about 78% of the time for short-term treatments but only 54%
for chronic illness.
A study by Becker (1972) looked at whether a prescribed antibiotic was being taken halfway through a 10 day treatment
programme in young children. Over half the mothers had
stopped giving the medicine.
WHY PATIENTS DO NOT ADHERE!
Rational Choice Theory: people may not adhere for
good reason:
1. They have reason to believe the treatment is not
working
2. The side effects are unpleasant or effect the
quality of their lives YouTube - Ambien Side
Effects -- Research Findings
3. There are practical barriers to the treatment
such as cost or social difficulties
4. They may want to check the illness is still there
when they stop.
BULPITT ET AL (1988)
 Aims: to review research on adherence
in hypertensive male patients.
Hypertension has no real short-term effects but in the long term can
lead to
heart disease and stroke.
 Method: Review article of range of
research which identified problems with taking medication for high blood
pressure.
 Procedure: Research analysed to identify the physical and psychological
effects of drug treatment on person’s life.
BULPITT ET AL (1988)
 Findings: anti hypertensive drugs have many side effects
including sleepiness, dizziness, lack of sexual functioning.
They also affect cognitive functioning and so work and
hobbies may be curtailed.
 In one study Curb (1985) found that 8% discontinued due to
sexual problems
 GMC 15% stopped due to side effects
 Conclusion: When the costs of taking medication (the side
effects) outweigh the benefits of treating a mainly
asymptomatic problem such as raised BP, patient is less likely
to adhere to treatment.
EVALUATION
G
R
A
V
E
Other e.g.
debates
HOW CAN WE MEASURE ADHERENCE?
WHAT PROBLEMS ARE THERE IN EACH?
1. Self-report – simply asking people - probably
with questionnaires
2. Therapeutic outcome – have they got better?
3. Health worker estimates – ask the doctor
4. Pill & bottle counts – raid the cupboard and see
what is left!
5. Mechanical methods – how much medicine has
been dispensed from the bottle?
6. Biochemical tests - blood and urine
DON’T ASK DRS ABOUT ADHERENCE
One of the least
affective ways (Ley
1997) of measuring
adherence is to ask
doctors as they appear
to vastly over estimate
the extent to which
their patients do
adhere.
CHUNG AND NAYA 2000
Was the first study to
electronically assess compliance
with an oral asthma medication.
Aimed to see if patients did take
their medication regularly and at
the correct time of day.
Taking regular asthma
medication reduces attacks and
prevents deaths. This study used
an electronic Track Cap, an
electronic device on the bottle
top that recorded the date and
time of the use of the
medication.
57 Patients were told that adherence rates were being measured but not told
about the Track Cap device and what it did. The treatment was taken twice
a day 8 hours apart.
The study was carried out over a 12 week period.
Compliance was measured by the number of times the track cap was opened,
the number of days that the track cap was opened at 8 hour apart intervals
and the number of pills left at the end of the 12 week period.
Over the period the track cap monitoring showed compliance was quite high at
71%. However the count of returned pills put the compliance rate even
higher at 92%. ( However 10 patients dropped out of the study leaving the
data being collected from only 47).
These results show that compliance with adherence to a treatment of oral,
twice a day asthma, maintenance medication is high.
LUSTMAN (2000)
Using physiological measure to assess adherence to medication and the
treatment of depression in diabetics.
Aim: to assess the effectiveness of fluoxetine as treatment for depression in
patients with diabetes
Method: lab experiment using a double blind technique and placebo control
Participants: 60 patients who volunteered to take part (self-selected sample)
Had either type 1 or type 2 diabetes and had been diagnosed with
depression.
LUSTMAN (2000)
Using physiological measure to assess adherence to medication and the
treatment of depression in diabetics.
Procedure: All patients screened for depression using the Becks Depression
Inventory
Randomly assigned to 2 groups
Grp 1: given fluoxetine
Grp 2: identical looking pill as
placebo
Daily does of medication for 8 wks
Patients and docs did not know
to which group they had been assigned – avoidance of demand
characteristics
Patients re-assessed for depression
Assessed on their adherence to their medical regime (e.g. changing
diet/administering insulin by injection) for controlling their diabetes through
measuring blood sugar levels.
LUSTMAN (2000)
Using physiological measure to assess adherence to medication and the
treatment of depression in diabetics.
Findings:
Reduction in depression symptoms was significantly greater in patietns
treated with fluoxetine compared with those receiving the placebo.
Researchers were able to measure that patients with nearer normal blood
sugar levels which indicated improved adherence to their regime.
Conclusions:
Measuring blood sugar levels in patients with diabetes indicates their level of
adherence to medical regimes.
Greater adherence shown by patients who were less depressed, suggesting
that reduced depression may improve adherence in diabetic patients.
EVALUATION
G
R
A
V
E
Other e.g.
debates
ESSAY PRACTICE
Write a paragraph outlining how self-report as a measure
of health adherence is reliabile.
Include a ‘slapback’
Write a paragraph explaining why someone may or may not
adhere to a medical regime – use evidence.
Write a paragraph outlining ethical issues that might crop
up when researching medical adherence.
WHAT IDEAS DID YOU COME UP WITH FOR
IMPROVING ADHERENCE DURING THE FIRST
LESSON?
EVALUATION
G
R
A
V
E
Other e.g.
debates
WATT: IMPROVING ADHERENCE TO TAKING
MEDICATION FOR ASTHMA
Using reinforcement for following medical regimen improves
adherence
•
•
•
•
When a person with asthma comes into
contact with something that irritates their
airways (an asthma trigger), the muscles
around the walls of the airways tighten so that
the airways become narrower and the lining of
the airways becomes inflamed and starts to
swell.
These reactions cause the airways to become
narrower and irritated - making it difficult to
breath
5.4m people in the UK are currently receiving
treatment for asthma
1.1m children in the UK are currently receiving
treatment for asthma
There is a person with asthma in 1 in 5
households in the UK
‘WATT’ IS ASTHMA?
•
Funhaler has incentive toys (spinner and whistle)
which function best when the child uses the deep
breathing pattern that ensures the effective
inhalation of the medication
WATT: IMPROVING
ADHERENCE TO TAKING
MEDICATION FOR ASTHMA
Aim
To see if using a Funhaler can improve children’s
adherence to taking medication for asthma through
reinforcement
WATT: IMPROVING ADHERENCE TO
TAKING MEDICATION FOR ASTHMA
Methodology
A field experiment (also qualifies as quasi because it uses children with asthma)
2 conditions
Uses self-report to measure adherence rates
WATT: IMPROVING ADHERENCE TO
TAKING MEDICATION FOR ASTHMA
Participants
32 Australian children (10M,22F)
 Aged 1.5 to 6, mean age 3.2
All diagnosed with asthma + prescribed drugs delivered by pressurised metered dose
inhaler (pDMI)
Parents gave informed consent
WATT: IMPROVING ADHERENCE TO
TAKING MEDICATION FOR ASTHMA
Design
Repeated measures design
One week usng pMDI “Breath-atech”
One week using Funhaler
WATT: IMPROVING ADHERENCE TO
TAKING MEDICATION FOR ASTHMA
Procedure
Child given Breath-a-Tech for 1 week and parents
given questionnaire
Child given Funhaler for 1 week and parents given
matching questionnaire at end of 2nd week
WATT: IMPROVING ADHERENCE TO
TAKING MEDICATION FOR ASTHMA
Findings
38% more parents were found to have medicated
their children the previous day when using the
Funhaler, compared to existing treatment
CONCLUSIONS
Funhaler can be remedy for non-adherence caused by boredom,
forgetfulness and apathy
 These were reasons shown by previous research for nonadherence
Adherence can improved by making it fun (positive reinforcement)
GROUP TASK
In pairs, answer the following questions
Please title your work ‘group classwork’: adherence to medical regimes
1. Explain why people may not adhere to medical regimes. (10)
Write a model answer for this question.
2. Discuss the difficulties of researching adherence to medical regimes. (15)
DON’T FORGET TO ALWAYS BACK UP YOUR POINTS WITH EVIDENCE AND TRY TO ENSURE
BALANCE IN YOUR ANSWER
SOME POINTS TO CONSIDER:
-
Research could impact professions
-
Defensiveness from individuals
-
Sensitive nature of the topic
-
Ethics
-
Demand characteristics
-
Social desirability
-
The methods themselves
HOMEWORK
Prepare for timed assessment –
revise, no notes allowed.
HOMEWORK
a) Describe one way to measure non-adherence
to medical advice. (10)
b) Discuss the usefulness of research into
adherence to medical regimes. (15)
EXAM QUESTIONS – 10 MARKERS
Describe one way to measure non-adherence to medical
advice. (10)
Explain why people may not adhere to medical regimes.
(10)
How could adherence to medical regimes be improved?
(10)
EXAM QUESTIONS – 15 MARKERS
Assess the reliability of research into non-adherence to medical
advice. (15)
Discuss the difficulties of researching adherence to medical regimes.
(15)
Discuss the usefulness of research into adherence to medical
regimes. (15)