Victoria Oladimeji (Ph.D., MA, MBA, BA, RGN, RM)

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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 [phone]

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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 patients 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.

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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.

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• 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)

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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.

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• 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. Beckers 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.
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• According to Becker (1974) the rationale behind
  the Health Belief Model is that the individuals
  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.

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• Diverse factors- Demographic, cultural, social
  and personality factors that may influence health
  behaviour.
• These link into the patients 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).

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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.

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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
• Cognitive (information and understanding)
• Affective (attitudes and feelings)
• Psychomotor (skills)
• Patient education needs to incorporate all three
  aspects.

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• 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

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Conclusion

• Medication compliance for patients with diabetes
  is one way of improving glycaemic control and
  minimizing some of the complications of diabetes.
  
• Application of Beckers 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.

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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 88973-976, 1995
• 5. Stuart B, Coulson NE Dynamic aspects of
  prescription drug use in an elderly population.
  Health Res 28237-264, 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 261468-1474, 2003
• 8. Wright EC Non-compliance or how many aunts
  has Matilda? Lancet 342909-913, 1993
• 9. Weingarten MA, Cannon BS Age as a major
  factor affecting adherence to medication for
  hypertension in a general practice population.
  Fam Practice 5294-296, 1988