Reasons For Poor Compliance Research Articles

Surgical site infection: poor compliance with guidelines and care bundles.

Surgical site infections (SSIs) are probably the most preventable of the health care-associated infections. Despite the widespread international introduction of level I evidence-based guidelines for the prevention of SSIs, such as that of the National Institute for Clinical Excellence (NICE) in the UK and the surgical care improvement project (SCIP) of the USA, SSI rates have not measurably fallen. The care bundle approach is an accepted method of packaging best, evidence-based measures into routine care for all patients and, common to many guidelines for the prevention of SSI, includes methods for preoperative removal of hair (where appropriate), rational antibiotic prophylaxis, avoidance of perioperative hypothermia, management of perioperative blood glucose and effective skin preparation. Reasons for poor compliance with care bundles are not clear and have not matched the wide uptake and perceived benefit of the WHO 'Safe Surgery Saves Lives' checklist. Recommendations include the need for further research and continuous updating of guidelines; comprehensive surveillance, using validated definitions that facilitate benchmarking of anonymised surgeon-specific SSI rates; assurance that incorporation of checklists and care bundles has taken place; the development of effective communication strategies for all health care providers and those who commission services and comprehensive information for patients.

Oral bisphosphonate compliance and persistence: a matter of choice?

Compliance to oral bisphosphonates is suboptimal, with negative consequences of increased healthcare utilization and less effective fracture risk reduction. Extending dose interval increased adherence only moderately. We used literature derived from multiple chronic conditions to examine the problem of noncompliance with osteoporosis medication. We reviewed the literature on adherence to osteoporosis medication as well as that across multiple chronic conditions to understand what is known about the cause of the poor adherence. Poor compliance to oral medications is due mostly, not to forgetfulness, but to deliberate choice. Gender differences and style of healthcare management also play a role. Preliminary data suggest psychobehavioral interventions may help to improve motivation. We need to understand better reasons for poor compliance before effective interventions can be developed. Forgetfulness is only a small part of poor compliance. Patient preferences must be considered in medication decision making.

Attitudes amongst Australian hospital healthcare workers towards seasonal influenza and vaccination.

Background Amongst healthcare workers (HCWs), compliance rates with influenza vaccination are traditionally low. Although a safe and effective vaccine is available, there is little Australian data on reasons for poor compliance, especially amongst allied health and ancillary support staff. Methods Cross‐sectional investigation of a sample of clinical and non‐clinical HCWs from two tertiary‐referral teaching hospitals in Sydney, Australia was conducted between June 4 and October 19, 2007. The self‐administered questionnaire was distributed to hospital personal from 40 different wards and departments. The main outcome measures were personal beliefs about influenza vaccination and self‐reported vaccination status. Results Respondents (n = 1079) were categorized into four main groups by occupation: nurses (47·5%, 512/1079), physicians (26·0%, 281/1079), allied health (15·3%, 165/1079) and ancillary (11·2%, 121/1079). When asked whether they felt the influenza vaccine was safe or effective, 81% (879/1079) and 68% (733/1079), respectively, replied in the affirmative. Participants felt that it was more important to get vaccinated to protect patients (74%, 796/1079) than family (68%, 730/1079) or self‐protection (66%, 712/1079). However, only 22% (241/1079) of the HCWs who replied reported receiving the vaccine the year the survey was conducted. Conclusions Although HCWs had an adequate level of knowledge towards influenza vaccination, only 22% of them were vaccinated. The approach to improving influenza vaccination rates amongst HCWs and to tackling misconceptions must be multifaceted, adaptable and must evolve regularly to increase coverage.

Seat Belt Use During Pregnancy in a Nigerian Community

This study was designed to determine compliance with car seat belt amongst antenatal patients and also identify the reasons for poor compliance with seat belt use. Ethical clearance was obtained from the Ethical Committee of the hospital prior to carrying out this study. This study was conducted between October and December,2007 at the antenatal clinic of Federal Medical Centre ,Owo , Ondo State, Nigeria. One hundred and four consenting respondents were selected by simple random sampling technique and interviewed by the authors and two assistants. Information regarding their bio data, compliance with seat belt use in pregnancy and reasons for poor compliance were obtained. The data obtained was collated and analyzed with SPSS 12.0.1 statistical soft ware package . 50(48.1%) used seat belt with varying degree of compliance and 54(51.9%) failed to use seat belt. Very few ;4(8%) used it always. 34(35.4%) attributed poor compliance with seat belt to discomfort while 33(34.4%) attributed it to fear of injury to the baby in the womb. Most respondents (51%) were informed about seat belt use in pregnancy by Road Safety Corps officers. A little over half of the pregnant women interviewed failed to comply with seat belt. Very few of them used seat belt always. Reasons for poor compliance with seat belt revolved mainly around fear of injury to the baby in the womb and discomfort. There is need for aggressive educational efforts to improve seat belt compliance amongst pregnant women . Keywords: Pregnant women, seat belt compliance, Nigeria.Nigerian Hospital Practice Vol. 2 (1) 2008: pp. 14-17

Trivalent Inactivated Influenza Vaccine Compliance Rate in Neonatal Intensive Care Unit Parents

The American Academy of Pediatrics (AAP) recommends injected, inactivated influenza vaccine for all close contacts of high-risk infants. This population includes parents of infants younger than 59 months of age, with an emphasis on children 0-6 months who are not direct candidates for immunization. This 0-6 month age group is a major component of the neonatal intensive care unit (NICU) population. No data exist on the compliance rate with influenza vaccine in this specific parent population. The purpose of this study was to assess the compliance rate among this parent population and compare it with vaccine use in the general adult population at the time, which has traditionally ranged from 25% to 32%. The study also sought reasons for poor compliance with flu vaccine. Answering this question is important in determining whether programs directly aimed at NICU parents are required to achieve compliance or if simply informing parents of the need to be immunized results in sufficient vaccination rates. For 14 weeks during the 2004-2005 influenza season, 92 randomly selected parents (from 56 inborn infants) underwent an informational program regarding influenza vaccine and the risks and benefits of vaccination. Parents were surveyed in the spring to assess if they obtained the injection the previous winter. Subjects were parents of NICU patients admitted to the New York University NICU during the 14-week study period. The main outcome measure was the influenza vaccination rate of the parental cohort that underwent the informational program. For those who intended to receive influenza vaccination but did not, reasons for noncompliance were assessed via standardized telephone interview. After the information session, 85 parents (92%) indicated they intended to obtain the vaccine; however 30 parents (32.6%) actually received it by the following spring. The most commonly cited reason for failing to obtain influenza vaccine was convenience. No correlation between parents who obtained the vaccine and infant birth weight, gestational age, or length of stay was observed. Compliance with national recommendations to obtain trivalent inactivated influenza vaccine in this highly specified parent population is roughly equivalent to the national average of all adults in the general population. Caregivers of high-risk neonates must encourage/offer immunization to this targeted population.

Compliance with hepatitis B immunisation commenced in hospital

Introduction: The UK implements a selective immunisation programme for hepatitis B virus (HBV), screening all pregnant women antenatally and targeting high-risk groups. At the time of this audit, babies considered to be at environmental risk of HBV were scheduled to be immunised at birth, 2 and 4 months. This included all babies of women booked to deliver within the Women’s Reproductive Health Service at the Princess Royal Maternity (PRM). The objective was to audit, through retrospective cohort analysis, compliance with the hepatitis B immunisation schedule in this group of babies. Methods: The study cohort included all babies who had received their first dose of hepatitis B vaccine at the PRM during the period 01/02/2005–01/03/2006. Infants considered to be at high risk of perinatal transmission were excluded. Sources of information were a database of infants notified directly to public health from the PRM, the Scottish Immunisation Recall System (SIRS), a database of infants born to drug misusing women at PRM and pharmacy records at PRM. Databases were compared to identify infants given one or more doses of hepatitis B vaccine. Results: A total of 203 infants were given a first dose of hepatitis B vaccine in the PRM and notified directly to public health. A further 36 infants were notified to SIRS by their GP. During the same study period, 274 doses of vaccine were dispensed by the pharmacy at PRM. One hundred and fifty-four (67%) infants were born to mothers who were known to be drug misusers. Only 52.8% of infants given their first dose of hepatitis B vaccination at the PRM completed the course (defined as more than three doses) and are therefore fully protected against HBV. In the drug-misusing population, the results were no better, with only 54.5% of infants completing the course. Conclusions: There are both clinical and practical reasons for poor compliance with hepatitis B vaccination, which include communication problems (including notification to public health), the mobility of the population, poor parental understanding, the increasing complexity of the childhood immunisation programme and problems with implementing selective rather than universal immunisation. An improved notification system, standardised consent form and parental information leaflet have been introduced. The cycle of audit will be completed after the changes have been implemented. The relationship between angiotensin-converting enzyme (ACE) genotype, serum ACE concentration and markers of asymmetrical growth restriction in premature infants

Added benefits of drospirenone for compliance

Drospirenone is a novel progestogen that possesses antimineralocorticoid activity. This activity is seen clinically in its effects on physiological parameters, body weight, general well-being and fluid-related symptoms.Clinical studies with an oral contraceptive containing 30 μg ethinylestradiol and 3 mg drospirenone (Yasmin®, Schering AG, Berlin, Germany) and a new continuous combined oral hormone replacement therapy (HRT) containing 1 mg 17β-estradiol and 2 mg drospirenone (Angeliq®, Schering AG) were all designed specifically to evaluate treatment effects on body weight and cardiovascular function, both of which can be influenced by aldosterone receptor antagonism.Weight gain during traditional oral contraceptive and HRT use has been one of the main reasons for poor compliance and discontinuation. Women receiving hormone therapy with 1 mg 17β-estradiol/2 mg drospirenone had either no weight change or a small decrease, while those receiving estradiol alone tended to increase in weight. Mean body weight after 1 year of treatment with 1 mg 17β-estradiol/2 mg drospirenone decreased by 1.2 kg (p < 0.001). Studies using different drospirenone doses in combination with estradiol indicate that the effect on body weight is dependent on the dose of drospirenone, and that this is due to drospirenone's antimineralocorticoid activity. These data are in agreement with previous studies that compared the changes in body weight in young women receiving for 13 or 26 cycles the oral contraceptives 30 μg ethinylestradiol/3 mg drospirenone or 30 μg ethinylestradiol/150 μg desogestrel (Marvelon®, Organon International); 30 μg ethinylestradiol/3 mg drospirenone had a more favorable effect on body weight, with the mean body weight remaining lower than baseline for the majority of women.A variety of physical and emotional changes have been linked to hormonal fluctuations during the menstrual cycle. Fluid retention-related symptoms, such as breast tenderness, swelling, abdominal bloating and skin changes, may affect well-being and quality of life. Improvements in these cycle-dependent disorders, together with some psychological symptoms, such as fatigue and depressive mood, are well documented with the use of 30 μg ethinylestradiol/3 mg drospirenone. Therefore, the effects of hormone therapy with 1 mg 17β-estradiol/2 mg drospirenone on quality of life were assessed in the Women's Health Questionnaire. Significant improvements were observed in quality of life during treatment with 1 mg 17β-estradiol/2 mg drospirenone, which also resulted in higher mean scores than estradiol alone. Improvements were mainly seen in somatic symptoms, anxiety/fears and cognitive difficulties.1 mg 17β-estradiol/2 mg drospirenone has unique antimineralocorticoid properties, which can be attributed to drospirenone. This combination prevents salt and water retention elicited by estrogens, and thereby prevents increases in blood pressure and maintains a stable body weight. Its additional beneficial impact on premenstrual symptomatology and health-related quality of life may improve well-being and clinical tolerance.

Home blood pressure teletransmission for better diagnosis and treatment.

The rate of control of high blood pressure is disappointing, and noncompliance is one factor that contributes to this. The reasons for poor compliance are complex and include factors related to the patient, the healthcare provider, and the medical system. In general, the lack of regular communication between the patient and the physician, as occurs in the traditional model of clinic-based care, predicts a low rate of blood pressure control. In addition, clinic-based blood pressure rates are notoriously unreliable. A solution to this dilemma is teletransmission of self- measured blood pressure readings, which offers the dual advantages of more reliable measurements, and the establishment of regular telephone communication between the patient and the healthcare provider. Preliminary evidence with this type of system suggests that blood pressure control can be improved substantially.

Minimizing the problem of poor compliance in adolescents. Clinical experience with a modern low-dose gestodene-containing oral contraceptive.

Adolescents represent a particularly difficult group with respect to compliance. Not only is incorrect pill intake a common problem, but unnecessary discontinuation also occurs regularly. Reasons for poor compliance are varied, but inadequate information and problems with cycle control and weight gain are particularly important. Choosing a well-tolerated oral contraceptive can help to improve compliance, and clinical experience from a large, multicenter trial suggests that monophasic gestodene (75 micrograms gestodene/30 micrograms ethinylestradiol) is a suitable preparation for this group of women. An investigation of 5,602 adolescents with an average age of 16.4 years found good contraceptive reliability and excellent cycle control. The incidence of spotting and breakthrough bleeding was low and declined during the course of the study. The preparation was tolerated well, and the incidence of adverse events was low, with only 4.4% of women withdrawing from the study due to adverse events. An increase in body weight was uncommon. At the end of the study, 85.0% of adolescents rated monophasic gestodene as good and 9.6% as satisfactory.

Glove utilization and reasons for poor compliance by health care workers in a Nigerian teaching hospital.

Glove utilization and reasons for poor compliance by health care workers in a Nigerian teaching hospital.

Treatment compliance in adults with cystic fibrosis.

The study comprised three interrelated aims: (1) to ascertain (a) patient compliance with physiotherapy, exercise, enzyme and vitamin regimens, (b) how compliance was perceived by patients, and (c) the reasons for poor compliance (2) to identify demographic and clinical variables associated with compliance; and (3) to determine how accurately patient compliance can be predicted by carers. Demographic and medical history data were obtained from medical records and a patient questionnaire. The data obtained included age, sex, employment status, inpatient or outpatient status, frequency of contact with the clinic, age at diagnosis, and the number of years practising physiotherapy. Measures of clinical status, including FEV1 and FVC percentage predicted, Shwachman score, and 24 hour sputum weight were recorded before completion of the questionnaire. The questionnaire, administered by a psychologist, assessed the reported degree of patient compliance, their perception of compliance, and their reasons for poor compliance. Sixty patients participated in the study and 51/60 and 41/55 patients were considered compliant with enzyme and exercise therapies, respectively. Compliance was lower with physiotherapy (32/60) and vitamin treatment (21/45). Patients reporting immediate benefits following exercise and physiotherapy were more compliant than those reporting no improvement. The perception by patients that compliance was sufficient ("about right") was physiotherapy 67%, exercise 37%, enzymes 78%, and vitamins 9%. Compliance was not influenced by demographic details nor by severity of disease, although patients producing large amounts of sputum and receiving help with physiotherapy were more compliant with physiotherapy. The physiotherapist and physician judged correctly the degree of compliance with physiotherapy in 83% and 75% of cases, respectively, and with exercise in 68% and 67% of cases, respectively. The reported degree of compliance and reasons for poor compliance were treatment specific. Demographic and disease severity variables were not associated with compliance. Those involved in the care of patients with cystic fibrosis were able to predict patient compliance.

Needlestick injuries in anaesthetists

A survey of needlestick injuries among 42 anaesthetists at this university hospital was carried out over a 3-month period to ascertain the rate of occurrence and the extent to which a revised protocol for the management of such injuries was followed. There were nine reported incidents, of which six were with contaminated needles. Three were reported. Eight anaesthetists had not taken up immunisation against hepatitis B. The rationale behind the revised protocol, and possible reasons for poor compliance are discussed.