Noncompliance In Patients Research Articles

Factors associated with therapy noncompliance in type-2 diabetes patients.

To identify the frequency and factors associated with therapy noncompliance in type-2 diabetes mellitus patients. A cross-sectional study was carried out in 79 patients with type-2 diabetes mellitus seen in major hospitals of Mexico City. Patients were visited at home, from March 1998 to August 1999, to measure compliance with prescribed therapy. Complying patients were defined as those taking at least 80% of their pills or 80% of their corresponding insulin dose. The degree of compliance with therapy components (diet, amount of exercise, and keeping appointments) was measured. The average age of study subjects was 59 years (SD 11 years); 73% (n = 58) were female subjects. The overall frequency of noncompliance was 39%. Noncompliance rates were: 62% for dietary recommendations, 85% for exercise, 17% for intake of oral hypoglycemic medication, 13% for insulin application, and 3% for appointment keeping. Hypertension plus obesity was the only factor significantly associated with noncompliance (OR 4.58, CI 95% 1.0, 22.4, p = 0.02). The frequency of therapy noncompliance was very high, especially for diet and exercise.

Predictors of noncompliance in patients with schizophrenia.

Around 50% of patients with schizophrenia do not fully comply with treatment, and noncompliance is linked to relapse, rehospitalization, poor outcome, and high economic costs. The health belief model views noncompliance as a decision made by the patient, arrived at after weighing the perceived risks and benefits of treatment. A MEDLINE search for the years 1980-2002 using combinations of the keywords schizophrenia, compliance, adherence, antipsychotics, tolerability, and side effects was used to identify articles investigating the factors influencing compliance in schizophrenia. Many factors influence compliance, including those that affect patients' beliefs about their illness and the benefits of treatment (e.g., insight into illness, belief that medication can ameliorate symptoms), perceived costs of treatment (e.g., medication side effects), and barriers to treatment (e.g., ease of access to treatment, degree of family or social support). Medication side effects that are distressing to patients and linked to noncompliance include extrapyramidal side effects, neuroleptic dysphoria, akathisia, sexual dysfunction, and weight gain. Compliance can be improved by cognitive-behavioral therapies, such as compliance therapy, and other psychosocial interventions associated with improved social functioning and a lower risk of rehospitalization. Treatment adherence may also be improved by use of atypical antipsychotics with few perceived side effects. By considering the factors leading to noncompliance and adopting a comprehensive strategy for improving compliance, encompassing psychosocial intervention and optimum choice of medication, the management of schizophrenia could be greatly improved.

Early detection and intervention programme for psychosis

We will present the demographics, quality of life, and illness characteristics of a group of patients with new‐onset psychosis, assessed by the Early Detection and Intervention Programme of Psychosis (EDIPP), initiated 1 year ago by the Massachusetts Department of Mental Health (DMH), Southeastern Area. The EDIPP is conducted by the crisis team, which includes clinicians, nurses, and psychiatrists and serves a population of approximately half a million people. Patients diagnosed with new‐onset psychosis (according to preset criteria) are referred for assessments, using the premorbid, quality of life, psychiatric, and cognitive evaluations. Up to 60% of patients cooperated with the follow up visits.A significant number of new‐onset psychotic patients (up to 50%), however, could not be contacted by staff for follow‐up, because during the crisis evaluation were sent to facilities outside the geographical area. Patients who cooperated with the follow‐up appointments had significant support in the community,especially families who understood their illness.The high likelihood of noncompliance in patients with new‐onset psychosis points to the need of integrated programmes that will address education and antistigma efforts in the community and provide sufficient therapeutic support. Such a programme needs to be based on a case‐management system and cannot be successfully accomplished as part of an academic or private endeavour alone outside DMH guidelines.

Noncompliance with medical follow-up after pediatric intensive care.

To describe the medical follow-up ordered, the health care utilization, the appointment compliance, and the risk factors associated with noncompliance in patients who are discharged after a pediatric intensive care unit (PICU) stay. A prospective, analytic, cohort study of 111 critically ill children, age 1 day to 16 years, who were admitted to a 30-bed PICU in an urban, tertiary-care, pediatric teaching hospital compared children who were compliant with medical follow-up with those who were not. The main outcomes measured were emergent and unscheduled physician visits during the first 6 weeks after hospital discharge; compliance with ordered medical follow-up after hospital discharge; and comparisons of socioeconomic, demographic, and medical need factors between compliant and noncompliant children. Discharge orders for follow-up appointments with general pediatricians and subspecialists were collected from the chart at hospital discharge. Patients were contacted after hospital discharge to determine whether and when they received medical follow-up; 28% were found to be noncompliant. Risk factors associated with noncompliance were evaluated. Emergent and unscheduled physician visits were tracked during the first 6 weeks after hospital discharge. Lack of follow-up orders at hospital discharge did not affect the frequency of emergent visits. Children fell into 2 groups: those who were 100% compliant and those with < or =67% compliance. No socioeconomic or demographic risk factors could be identified between the 2 groups. Compared with the 100% compliant patients, patients who were compliant with < or =67% of appointments were more severely ill, as defined by higher peak pediatric risk of mortality scores during their PICU stay (11.5 vs 8.4), longer PICU length of stays (10.1 days vs 4.6 days), and longer hospital length of stays (25.5 days vs 14 days). Most predictive of noncompliance was the number of medical appointments ordered by physicians. Patients with 3 or more appointments were less likely to be compliant with follow-up. After hospital discharge, children were more likely to visit a primary care physician compared with a subspecialist (95% vs 82%). When patients were ordered to see a specialist, scheduled appointments were much better attended than the recommended appointments (92% vs 67%). Lack of ordered medical follow-up did not affect emergent visits. In this group of critically ill children, a significant percentage (28%) did not receive timely medical follow-up. No socioeconomic or demographic risk factors were identified in noncompliant children. However, severity of illness (higher peak pediatric risk of mortality score, longer PICU stay, and longer hospital stay) and the number of follow-up appointments ordered were predictors of noncompliance. Potential exists for implementing strategies to improve compliance in identified populations.

Predictors of noncompliance in males with first-episode schizophrenia, schizophreniform and schizoaffective disorder

Purpose. Many factors influencing compliance in schizophrenia have been reported in the literature. Our aim was to assess predictors of noncompliance in male patients with first-episode schizophrenia, schizophreniform and schizoaffective disorder in a naturalistic setting. Subjects and methods. Fifty-six male patients, discharged from hospital, were included in a 1-year follow-up study. Psychopathological symptoms were assessed with positive and negative syndrome scale at admission and discharge, while extrapyramidal side effects were recorded weekly during hospitalisation using the Simpson–Angus and Barnes akathisia scales. Socio-demographic and some other variables were also recorded. Results. Thirty patients (53.6%) dropped out of treatment in the first year and 21 of them relapsed. With the Cox survival analysis three predictors of noncompliance were found: diagnosis of schizophrenia versus the other two diagnoses, positive symptoms at admission, and lack of insight at discharge. Discussion. In spite of a specific methodology and selection of only first-episode male patients, the results are in accordance with the findings of other authors. This confirms the universality of noncompliance in psychotic patients. Conclusions. First-episode patients have a high dropout rate. However, in compliant patients, the relapse rate was low, and therefore special attention and compliance-promoting interventions in first-episode patients are needed.

Predictors of noncompliance in patients with schizophrenia

Predictors of noncompliance in patients with schizophrenia

Factors Associated with Noncompliance in Psychiatric Patients an Indian Experience

Factors Associated with Noncompliance in Psychiatric Patients an Indian Experience

Compliance with CPAP therapy in older men with obstructive sleep apnea.

Factors specifically affecting compliance with continuous positive airway pressure (CPAP) in older patients with obstructive sleep apnea (OSA) have not been described. The purpose of this study is to determine which factors are associated with compliance and noncompliance in older patients, a growing segment of the population. A retrospective chart review of older male patients prescribed CPAP therapy for OSA over an 8-year period. Veterans Affairs Medical Center. All patients age 65 and older for whom CPAP therapy had been prescribed for treatment of OSA in the past 8 years. Records of all older male patients prescribed CPAP therapy for OSA over the last 8 years were reviewed. Compliance was defined by time-counter readings averaging 5 or more hours of machine run-time per night. Of 33 older male patients with OSA studied, 20 were found to be compliant and 13 noncompliant with nasal CPAP therapy. The mean age (+/- SEM) at the time of diagnosis of OSA in the compliant group was 68 (+/-1) years, whereas that of the noncompliant group was 72 (+/-1) years (P <.05). Of the compliant patients, 95% attended a CPAP patient education and support group, whereas only 54% of noncompliant patients attended (P =.006). Resolution of initial symptoms of OSA with CPAP therapy was significantly associated with compliance. Symptom resolution occurred in 90% of compliant patients and in only 18% of noncompliant patients (P <.0002). Factors that were significantly associated with noncompliance with CPAP were cigarette smoking, nocturia, and benign prostatic hypertrophy (BPH). Of noncompliant patients, 82% complained of nocturia, whereas only 33% of compliant patients complained of nocturia (P =.02). BPH was diagnosed in 62% of noncompliant patients and in only 15% of compliant patients (P =.004). Diuretic use was more common in the compliant group and, therefore, was not a cause of increased nocturia in noncompliant patients. In older male patients with OSA, compliance with CPAP therapy is associated with attendance at a patient CPAP education and support group. Resolution of symptoms with therapy also appears to be associated with enhanced compliance. In addition, we found an association between nocturia and the existence of BPH in older men with OSA who are not compliant with nasal CPAP. Larger observational studies should be performed to confirm these findings, and, if so confirmed, then further studies to determine whether treatment of BPH in older men with OSA improves compliance with CPAP.

Prophylactic long-term therapy of affective disorders with lithium, valproic acid and carbamazepine--effectiveness and cost-effectiveness

Affective disorders have a substantial public health impact due to morbidity, mortality, quality of life impairment and economic implications. There has been renewed debate of the efficacy and effectiveness of Lithium in long-term treatment of affective disorders. In the present paper current literature is discussed with a focus on the routine use of Lithium (effectiveness) and on cost aspects. Recent reviews have confirmed the prophylactic efficacy of Lithium in bipolar affective disorders. However, there is some evidence that effectiveness studies do not hold what efficacy research would promise. Non-compliance is likely to be a major reason for this. Lithium response rates have declined in recent studies. This may be related to diagnostic change (broader concept of affective disorders) and more widespread Lithium use. Non-compliance in patients taking Lithium is a primary factor in relapse with substantial cost effects (due to inpatient care). Current studies compare Lithium with Valproic acid/divalproex, and find cost advantages for the latter possibly due to better compliance. A special suicide-preventive effect has only been proven for Lithium. To ensure the full prophylactic potential of Lithium compliance needs to be improved. Future studies will compare Lithium with Valproic acid/divalproex, Carbamazepine and new treatment strategies more detailed.

Incidence of non-compliance in asthma patients: current research status and methodological problems

Incidence of non-compliance in asthma patients: current research status and methodological problems

Solid organ transplantation: are there predictors for posttransplant noncompliance? A literature overview.

Many studies confirm that noncompliance or poor compliance is one of the great problems in health care as it results in waste of resources and funds. This overview includes literature on heart, liver, and kidney transplants with emphasis on heart transplantation in adult and pediatric transplant patients and addresses the following variables as potential predictors of postoperative compliance problems: demographic variables (age, marital status, gender) psychological variables (anxiety, denial) psychiatric disorders (major depression, anxiety, and personality disorders), poor social support, pretransplant noncompliance, obesity, substance abuse, and health-related variables (distance from transplant center, indication for transplantation, required pretransplant assist device). Relevant studies on these topics that were conducted up to 1999 are included and discussed in this overview. The most important results are presented in tables. Unfortunately, there has not been any systematic and comprehensive review of the literature on predictors of noncompliance in organ transplant patients so far. With organ transplantation noncompliance impairs both life quality and life span as it is a major risk factor for graft rejection episodes and is responsible for up to 25% of deaths after the initial recovery period. Therefore, it might be assumed that well-informed transplant patients are a highly motivated group whose compliance is just as high. This is not the case. However, even when graft loss means loss of life as in heart or liver transplantation, noncompliance occurs. To best select potential organ recipients, it would be ideal if patients who are very likely to show noncompliant behavior could be identified already before being transplanted. The literature overview shows the necessity of preoperative psychosocial screening regarding predictors for posttransplant noncompliance.

A Study of the Relationship Among Self-Reported Noncompliance, Symptomatology, and Psychological Variables in Patients with Asthma

We examined the association among self-reported noncompliance and clinical status, symptomatology, functional activity, and psychological variables in asthma. Eighty-five asthmatics, who were hospitalized (H group), outpatients previously hospitalized (OH group), or outpatients not previously hospitalized (O group) completed questionnaires. Compliance was assessed during a structured interview. The higher prevalence of self-reported noncompliance in H group and OH group, compared to O group, was not explained by differences in respiratory function. Self-reported noncompliance was related to symptoms and emotional distress associated with disease and treatment, but not to functional or emotional status. A patient subgroup that catalogued itself as non-compliant may also be at risk for hospitalization, and was characterized by emotional distress associated with disease and treatment.

Cognitive Strategies and Self-Esteem as Predictors of Brace-Wear Noncompliance in Patients with Idiopathic Scoliosis and Kyphosis

Cognitive Strategies and Self-Esteem as Predictors of Brace-Wear Noncompliance in Patients with Idiopathic Scoliosis and Kyphosis

Compliance and noncompliance in kidney transplant patients: cues for transplant coordinators.

Maximizing kidney transplant patients' long-term compliance with immunosuppressants is a major challenge to transplant coordinators. Although previous research has found substantial proportions of recipients to be noncompliant, predictors of noncompliance and characteristics of noncompliers remain unclear. In this study of more than 1400 kidney transplant patients, we found noncompliance to be associated with patient and transplant characteristics and with patient beliefs concerning the efficacy of immunosuppressants. Three distinct profiles of noncompliers were identified: accidental noncompliers, invulnerables, and decisive noncompliers. This information can be used by transplant coordinators to recognize cues that predict noncompliance and to work with at-risk patients to forestall or remedy noncompliant behavior.

Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice

Researchers and clinicians have used numerous methods in their attempts to adequately assess patient compliance (adherence) with medication regimens and to identify noncompliant patients. Large variations have been reported in the extent of noncompliance in individual patients and large populations. In addition, nonadherence has often been poorly defined. Direct measures of adherence include drug assays of blood or urine, use of drug markers with the target medication, and direct observation of the patient receiving the medication. Indirect measures of adherence imply that the medication has been used by the patient; these measures include various forms of selfreporting by the patient, medication measurement (pill count), use of electronic monitoring devices, and review of prescription records and claims. Compliance measures should be assessed on the basis of their validity (sensitivity and specificity or statistical correlation) and the reference standard used. Many early studies used pill counts as a reference standard, but electronic monitoring devices such as the Medication Event Monitoring System have replaced pill counts as the reference standard. The choice of a method for measuring adherence to a medication regimen should be based on the usefulness and reliability of the method in light of the researcher's or clinician's goals. Specific methods may be more applicable to certain situations, depending on the type of adherence being assessed, the precision required, and the intended application of the results.

Compliance and Noncompliance in Kidney Transplant Patients: Cues for Transplant Coordinators

Maximizing kidney transplant patients' long-term compliance with immunosuppressants is a major challenge to transplant coordinators. Although previous research has found substantial proportions of recipients to be noncompliant, predictors of noncompliance and characteristics of noncompliers remain unclear. In this study of more than 1400 kidney transplant patients, we found noncompliance to be associated with patient and transplant characteristics and with patient beliefs concerning the efficacy of immunosuppressants. Three distinct profiles of noncompliers were identified: accidental noncompliers, invulnerables, and decisive noncompliers. This information can be used by transplant coordinators to recognize cues that predict noncompliance and to work with at-risk patients to forestall or remedy noncompliant behavior.

Posttransplant quality of life issues: depression-related noncompliance in cardiac transplant patients

Posttransplant quality of life issues: depression-related noncompliance in cardiac transplant patients

The Relationship Between Medication Noncompliance and Cognitive Function in Patients With Schizophrenia

BACKGROUND:The relatively high rate of medication noncompliance in patients with schizophrenia may be in part the result of cognitive impairments frequently associated with the disorder. OBJECTIVE: The purpose of this study was to determine whether baseline performance on specific neurocognitive tests predicts a patient's level of medication compliance. The question of whether improvement on these same tests after 3 months of antipsychotic treatment would correlate with medication compliance was also examined in this study. DESCRIPTVE CORRELATIONAL DESIGN: Patients' medication compliance (on a percentage basis) was correlated with their baseline and 3-month posttreatment scores on four neurocognitive tests. RESULTS: A statistically significant relationship exists between medication compliance and patients'performance on tests of attention and immediate visual recall CONCLUSION: The results of this study support the implementation of interventions that ameliorate specific neurocognitive deficits that, in turn may facilitate improved medication compliance.

The relationship between medication noncompliance and cognitive function in patients with schizophrenia

Abstract Background : The relatively high rate of medication noncompliance in patients with schizophrenia may be in part the result of cognitive impairments frequently associated with the disorder. Objective : The purpose of this study was to determine whether baseline performance on specific neurocognitive tests predicts a patient's level of medication compliance. The question of whether improvement on these same tests after 3 months of antipsychotic treatment would correlate with medication compliance was also examined in this study. Descriptive Correlational Design : Patients' medication compliance (on a percentage basis) was correlated with their baseline and 3-month posttreatment scores on four neurocognitive tests. Results : A statistically significant relationship exists between medication compliance and patients' performance on tests of attention and immediate visual recall. Conclusion : The results of this study support the implementation of interventions that ameliorate specific neurocognitive deficits that, in turn, may facilitate improved medication compliance.

Profiles of noncompliance in patients with a functioning renal transplant: a multicenter study

There are only a limited number of studies that have sought to identify patients at high risk for medication errors and subsequent adverse clinical outcomes. This study sought to identify risk factors for increased health care resource utilization in kidney transplant recipients based on drug-related problems and self-administered surveys.In this prospective observational study, adult kidney transplant recipients seen in the transplant clinic between September and November 2015 were surveyed for self-reported demographics, medication adherence, and health status/outlook. Subsequently, patients were assessed for associations between survey results, pharmacist-derived drug-related problems, and health resource utilization over a minimum 6-mo follow-up period. Based on univariate associations, two risk cohorts were identified and compared for health care utilization using multivariable Poisson regression.A total of 237 patients were included, with a mean follow-up of 8 mo. From the patient survey data, Medicaid insured or self-rated poor health status were identified as a significant risk cohort. From pharmacist assessments, those who received incorrect medication or lacked appropriate follow-up medication monitoring were identified as a significant risk cohort (pharmacy errors). The Medicaid insured or self-rated poor health status cohort experienced 43% more total health care encounters (incident rate ratios [IRR] 1.43, 1.01-2.02) and 35% more transplant clinic visits (IRR 1.35, 1.03-1.77). The pharmacy errors cohort experienced 4.2 times the rate of total health care encounters (IRR 4.17, 1.55-11.2), 4.1 times the rate of hospital readmissions (IRR 4.09, 1.58-10.6), and 2.3 times the rate of transplant clinic visits (IRR 2.31, 1.04-5.11).Medicaid insurance, self-rated poor health status, and errors in the medication regimen or monitoring were significant risk factors for increased health care utilization in kidney transplant recipients. Further research is warranted to validate these potential risk factors, determine the long-term impact on graft/patient survival, and assess the mutability of these risks through prospective identification and intervention.