Compliance Behavior Of Patients Research Articles

Part II: the role of trust in patient noncompliance: a quantitative case study of users of statins for the chronic treatment of high cholesterol in New York City

It is widely known that increased perceived risk associated with a drug, even if in a completely different class of medicines, may influence patient compliance to their treatment regimes. Media reports of alleged scandals and controversies associated with certain prescription drugs, such as Vioxx, are easily accessible in public recollections and may influence attitudes towards other drugs. Reports of increased noncompliance following such media reports contribute to the existing 50–70% of the US adult population of chronic prescription users who do not take medications in accordance with physicians’ instructions. This can have impacts ranging from faster onset of disease for the noncompliant individual to wider impacts for society as a whole, such as increased federal spending on social health funds. The rates of noncompliance described, and their alleged relationship with increased public suspicions, suggest a role for trust in shaping compliance behavior in patients. This study applied the mental models approach for the purpose of understanding lay perceptions in relation to existing scientific information on the risk of noncompliance. In accordance with the approach, 30 participants were interviewed, and 200 questionnaires were administered in New York City to eligible users of statins for the chronic treatment of high cholesterol. This original research reports the primary findings from the 200 confirmatory questionnaires in relation to the qualitative interview findings from the previous article. The themes of distrust in various actors in the health care system identified during the interviews were supported statistically through the questionnaires, and a statistically significant correlation between distrust and noncompliance was established. The results of this research should be taken into consideration for any future efforts at addressing risks associated with patient noncompliance.

Application of pipe file registration card in urology pipe management

Objective To explore application effect of pipe file registration card in urology pipe management.Methods 120 patients who received treatment in July 2010 were divided into experimental group and control group randomly and each group had 60 patients.General guidance were trained in two groups.Pipe file registration cards were used in experimental group.Surveys and analysis were conducted on fluid flowing,safety,extubation,compliance behavior of patients,omissions replace number,satisfaction investigation results when they left the hospital.Results Numbers of patients with drainage,sense of security,smooth pipe,compliance behavior were 55,54,40 and 55 in experimental group,whereas 25,24,10 and 25 in control group,the difference was statistical significant ( x2 =6.91,7.16,13.11,6.91,20.02,respectively; P ＜ 0.01 ).Conclusions The establishment of pipe file registration card can standardize nursing operation,form orderly work process,improve nursing quality and treatment effect,and improve patient satisfaction. Key words: Pipe file registration card; Urology; Pipe management

What determines the duration of patient medication compliance in patients with chronic disease: are we looking in the wrong place?

Objectives: The objective of this study was to do a pilot inquiry, to determine whether physicians with similar practices in the same neighborhood demonstrated any difference in the duration of compliance among their patients.Methods: Through a cooperating urban community pharmacy, patients with prescriptions for hypertension and type II diabetes were identified for this pilot study. Patients refill medication records were searched to determine the average number of months of drug regimen compliance. The patient data of the four local physicians were separated and compared.Results: One physician was able to generate refill durations nearly double that of the average duration of medication refills seen in the patients consulting the several other nearby physicians.Conclusion: In this pilot study, it was determined that there are differences in the compliance behavior of patients attending different physicians. We can conclude that some communication or personality characteristics of some physicians appear to be more successful in achieving higher compliance. Subsequent studies should identify those which may be at least partially responsible for this finding.

English

Pharmacological therapy is a critical step in the management of individuals with the metabolic syndrome (MetS) when lifestyle modifications cannot achieve the therapeutic goals. However, it has been well-documented that there is no single best therapy other than weight loss, and that treatment should be targeted at individual components of the MetS. The objective of this study was to investigate the treatment of individual components of the MetS in a population-based sample of individuals with clustering MetS components. In a cross-sectional population-based survey, we studied a randomly collected sample of men and women who had participated in the baseline survey of a community-based program in three Central Iranian counties in 2000 to 2001. Demographic data, medical status, and drug history were obtained by questionnaire. We evaluated the association between clustering of the MetS components and pharmacological treatment of cardiovascular risk factors. The most common pharmacologic agents prescribed for individuals with the MetS were beta-blockers (72.8%), followed by lipid-lowering agents (36%) with no significant gender difference. A high level of compliance with drug treatment was noted. Further research is warranted to understand the compliance behavior of patients with the MetS.

PHARMACOLOGICAL TREATMENT OF CARDIOVASCULAR RISK FACTORS IN INDIVIDUALS WITH METABOLIC SYNDROME: FINDINGS FROM THE ISFAHAN HEALTHY HEART PROGRAM: PP.5.197

Aim: Pharmacological therapy is a critical step in the management of individuals with Metabolic Syndrome (MetS) when lifestyle modifications can not to achieve the therapeutic goals. However, it is well-documented that other than weight loss, there is no single best therapy, and the treatment should consist of treatment of individual components of the MetS. The objective of this study was to investigate treatment of individual components of the MetS among a population –based sample of individuals with the clustering of those components of the MetS. Methods: A cross-sectional survey population-based examined a randomly collected sample of men and women living in three counties in central Iran participating in the baseline survey of a community –based program in 2000–2001. A questionnaire was completed for all participants to collect data regarding their demographic characteristics, medical status and history of medication use. In this study we determined the association between clustering of MetS components and pharmacological treatment of cardiovascular risk factors. Results: The most common pharmacologic agent received by individuals with MetS were beta blockers (72.8%) used for controlling high blood pressure, followed by lipid lowering agents (36%) without significant difference in trend of gender. Conclusion: Our results exhibited a high level of compliance with drug treatment. Further research is needed to better elucidate the compliance behavior of patients who have been diagnosed with MetS.

Metabolic Syndrome Patient Compliance with Drug Treatment

OBJECTIVES1) To evaluate the compliance with drug treatment in patients with metabolic syndrome. 2) To determine association between access to and use of medicines, as well as the level of knowledge of cardiovascular risk factors and compliance.INTRODUCTIONLow compliance has been one of the greatest challenges for the successful treatment of chronic diseases. Although this issue has been widely studied in patients with isolated hypertension, diabetes and dyslipidemia, compliance studies involving patients with these concomitant diseases or with metabolic syndrome diagnosis are scarce.METHODSThis was a cross-sectional study involving patients who have been diagnosed with metabolic syndrome according to the IDF criteria. Patients were being treated in a Health-Medical School Center bound to the Public Brazilian Healthcare System. This study was conducted in two phases. Phase I was characterized by analyzing medical records and Phase II involved interviewing the patients. A variation of the Morisky-Green Test was used to evaluate compliance. Compliance was the dependent variable and the independent variables included access to medicines, the use of medicines and the level of knowledge concerning cardiovascular risk factors.RESULTSTwo hundred and forty-three patients were identified as being eligible for Phase II, and 75 were included in the study. The average level of compliance was 5.44 points (standard deviation of 0.68), on a scale ranging from 1.00 to 6.00 points. There was no statistically meaningful association between independent variables and compliance. The level of patient knowledge of diet and dyslipidemia was considered to be low.CONCLUSIONSPatients involved in this study exhibited a high level of compliance with drug treatment. Further research is needed to better elucidate the compliance behavior of patients who have been diagnosed with metabolic syndrome.

Influence of Health Education on Compliance Behavior of Patients with Diabetes Meillitus

Objective To investigate the effects of health education on enhancing the compliance behavior of patients with diabetes mellitus (DM). Methods 63 DM patients were provided with systemic health education during their staying in the hospital. A follow-up interview was performed at the 6th month of discharge to gather the information of how importance of compliance behavior on the prognosis of DM. Result After the systemic health education, the patients could take medicine on time and had a good behavior in daily life, which will effectively improved their quality in the future life.Conclusion Systemic the health education can improve the compliance behavior of patients, and thus directly affects the prognosis of DM. Key words: Diabetes mellitus; Compliance behavior; Health education

Effectiveness of health education on compliance behavior of patients with colpitis

目的 探讨健康教育对改善阴道炎患者遵医行为依从程度的效果及其对疗效的影响.方法 对370例阴道炎患者随机分为实验组187例和对照组183例,实验组采取举办阴道炎知识讲座、发放健康教育处方等形式进行宣教,对照组按常规给予指导.比较2组患者遵医行为的差异.结果 实验组对阴道炎知识的知晓率为100%,对照组为74%,实验组明显高于对照组(P＜0.01).实验组对医嘱的遵从率高于对照组,症状复发率明显低于对照组(P＜0.05).结论 健康教育不仅可以提高患者对阴道炎知识的认知程度,还能提高患者的遵医行为,促进康复,预防复发,提高生活质量。

Effect of clinical nursing pathway on compliance behavior of patients with lumbar disc herniation

目的 探讨实施护理干预对腰椎间盘突出症患者遵医行为的影响.方法将92例患者按入院时间先后随机分为观察组46例和对照组46例,观察组按照临床护理路径实施护理干预,对照组给予常规护理和传统的健康教育.比较2组患者遵医行为、出院时症状改善情况、患者的住院天数、180 d内复发率.结果观察组患者遵医行为、出院时症状临床控制率、住院天数均明显低于对照组,与对照组相比有显著差异(P《0.01).结论应用临床护理路径实施护理干预可显著改善腰椎间盘突出症患者遵医行为,增强治疗效果,降低住院天数和疾病复发率。

Psychological Impact of the Physician-Patient Relationship on Compliance: A Case Study and Clinical Strategies

This article presents a case of a heart transplant recipient's noncompliance. A patient's probable medical compliance is among the primary psychosocial criteria in determining his or her eligibility for a heart transplant. The ability to predict and facilitate patient compliance remains a challenge to physicians in all areas of medicine and surgery. The accuracy of the compliance prediction is often contingent upon information generated by patient interviews, other medical personnel, and the patient's family members. All too often, this vital information is based on subjective data, creating difficulty for physicians in appraising patient compliance behavior. Such an amorphous data gathering process may leave physicians at a loss to explain the nature and extent of their patients' behaviors. Research has yet to provide consistent objective measures for compliance prediction. Patient compliance affects all corridors of medical practice and is responsible for an innumerable loss of human life, and financial resources each year.

Psychological impact of the physician-patient relationship on compliance: a case study and clinical strategies

This article presents a case of a heart transplant recipient's noncompliance. A patient's probable medical compliance is among the primary psychosocial criteria in determining his or her eligibility for a heart transplant. The ability to predict and facilitate patient compliance remains a challenge to physicians in all areas of medicine and surgery. The accuracy of the compliance prediction is often contingent upon information generated by patient interviews, other medical personnel, and the patient's family members. All too often, this vital information is based on subjective data, creating difficulty for physicians in appraising patient compliance behavior. Such an amorphous data gathering process may leave physicians at a loss to explain the nature and extent of their patients' behaviors. Research has yet to provide consistent objective measures for compliance prediction. Patient compliance affects all corridors of medical practice and is responsible for an innumerable loss of human life, and financial resources each year.

Analysis of Factors Related to Medication Compliance in Elderly Patients: A Survey of Outpatients in the Department of Internal Medicine of Oita Medical University Hospital.

Objectives: Studies on the state of medication compliance in Japanese elderly patients are not comprehensive with respect to the patient's perception of health, modifying factors of medication, and likelihood of the patient actually taking the medication. The present study was conducted to investigate factors that influence medication compliance in elderly patients, compared with factors in younger patients.Methods: One hundred and one elderly (65 years or older) and 105 younger outpatients (younger than 65 years) who were receiving drug therapy in the Department of Internal Medicine of Oita Medical University Hospital were directly interviewed using a questionnaire based on the health belief model for compliance behavior.Results: When compared with younger patients, even though more elderly patients took greater numbers of different pharmaceutical preparations of drugs and received prescriptions from 2 or 3 physicians, the medication compliance score was better in elderly patients (p<0.01). The results showed that the length of drug therapy, past experience with adverse drug reactions, patient-physician relationship, anxiety about drug therapy, and patients' judgment about the effects of drug therapy were the factors that influence the medication compliance in both elderly and younger patients. However, factors such as sex, the frequency of medications per day, dosage, the number of prescriptions, and knowledge of drugs did not correlate with medication compliance in either group.Conclusions: When compared with younger patients, elderly patients showed better medication compliance among outpatients of the university hospital. The present study suggests that the role of medical staff (physicians, nurses, pharmacists) in decreasing patients' anxieties with respect to the safety and effectiveness of drugs taken and in making better communication with patients is important in improving patient's compliance behavior.

Antibiotic misuse in diarrhea. A household survey in a mexican community

A survey of 1659 households in a periurban community in Mexico City was carried out to assess the frequency of and risk factors for inappropriate antimicrobial therapy in acute diarrhea. The housewife was interviewed to obtain information of the occurrence of diarrhea or use of an antibiotic in the previous 2 weeks by any member of the family. An antibiotic was used in 37% or 287 diarrheal episodes although only in 5% of all episodes was this therapy indicated, based on the presence of gross blood in stools. Patients seen by a physician were 6 times more likely to be treated with an antibiotic compared to those who did not consult a physician ( p < 0.001). Self-medication was associated with a higher risk of using an inadequate drug or dose (in 72% of treated episodes) and of following treatment for less than 5 days (in 66% of treated episodes). Other risk factors significantly and independently associated with antibiotic misuse were: an increased number of stools (odds ratio [OR] = 1.21; 95% confidence interval [CI] = 1.04, 1.41), bloody diarrhea (OR = 19.04; 95% CI = 2.52, 160.90) and family crowding (OR = 2.07; 95% CI = 1.17, 3.63). These findings support future community-oriented educational interventions aimed at improving physician prescribing practices and patient compliance behavior in order to achieve a more rational use of antibiotics.

The clinical and psychological indicators of behavior in wearing a removable appliance

Compliance with wearing removable appliances cannot be determined directly from progress noted in the course of treatment. The orthodontist's judgement is influenced by many and varied observations and the evidence they yield is often unclear. We studied 104 orthodontic patients aged nine to 16 years using as data treatment records, provider and patient questionnaires, and oral hygiene indexes. In addition the Luescher psychological color test was administered to a subgroup and the duration of compliance wear was objectively measured. We found little consistency among different compliance indicators. Studying the patient's keeping of appointments, his oral hygiene habits, and appliance maintenance did not result in general conclusions pertaining to the patient's compliance with wearing the appliance. Only over a longer period it is possible to determine through clinical observation the patient's cooperation in his treatment. More promising on the other hand for better evaluating patient compliance behavior is the combination of information obtained clinically with the results obtained through psychological tests.

An evaluation of the components of compliance in patients with diabetes

In the past, research directed at understandig patient compliance behavior has generally resulted in findings that were not predictive of compliance or what were at best contradictory. A study of 98 adult patients with diabetes as conducted to investigate some of the variables affecting compliance in that patient population. Compliance and knowledge scores were computed for all 98 patients interviewed. Twelve patients at each extreme of the compliance distribution (no. = 24) were selected for further interviews. Nonparametric analyses were used to test for group differences. Significant differences were found in the mean values for the following variables (mean± standard error of the mean for low and high compliers): years diabetic, 5.7 ± 1.5 and 12.1 ± 2.4, respectively (p =. 05); knowledge scores, 12.2 ± 1.4 and 20.9 ± 2.6, respectively (p=.001); and Health Belie f Model score, 35.5 ± 2. 647.2 ± 1.2, respectively (p =. 002). In addition, significant differences were found in the use of home glucose monitoring, which was practiced by 33% of low compliers and 100% of high compliers (p =. 002). No significant differences were found between the group sex, marital status, employment status, or ethnicity. The patients' perception of health c re delivery and the knowledge acquired about the disease cond1t1on appeared to be important factors that had a bearing upon the control the patients chose to exert upon their care. There also appears to be some indication that the Health Belief Model can be used for predicting compliance. perhaps the real difference in the two groups lies in the ability of the high compliance group to respond to environmental cues and feedback as provided through education, the taking of insulin, and the practice of home blood glucose monitoring. J Am Diet Assoc 88:708, 1988.

Patient compliance behavior: The effects of time on patients' values of treatment regimens

Present medical models of treatment compliance have not addressed the role that time plays in the perception of a treatment regimen's costs and benefits. This paper re-evaluates the role of time in understanding compliance behavior. Models from the economic and psychological literature are used to demonstrate that the ‘discounting effect’ associated with future events, and the ‘sunk cost effect’ associated with past events may have a direct and predictable impact on the patient's values in health care choices. This article suggests that when the effects of time are incorporated into expectancy models of compliance behavior (such as the Health Belief Model) the resulting predictions are supported by numerous findings in the compliance literature, many of which were previously unaccountable by these expectancy models. From this finding an explanation is derived for the variable results of educational and attitudinal change programs upon compliance behavior, the success of patient contracts, the sudden occurence of preference reversals in health care choices, and the ‘confusing’ effect of treatment cost on treatment adherence. This paper also introduces to the compliance literature the concept of a treatment's time adjusted rate of return’, and speculates upon how this concept may be used to understand the relationship between a treatment's ‘desirability’ or its ability to motivate a person to start the treatment, and its ‘resistance’ or its capacity to help a person to finish the treatment once it has begun. It proposes (1) that changes in the temporal distribution of a treatment's benefits and costs can improve the treatment's desirability and resistance, and (2) that a treatment's time adjusted rate of return can be used to allocate more efficiently the effort that provides spend monitoring patient compliance.