Patient compliance, patient education and ego defense.
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Defense Mechanisms↗
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Results for “Patient Compliance”
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Modifying the treatment: patient compliance, patient control and medical care.
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California↗
Issues in patient compliance.
Patient compliance refers to the willingness and ability of an individual to follow health-related advice, to take medication as prescribed, to attend scheduled clinic appointments and to complete recommended investigations. It is a major health issue, with outcomes related to levels of morbidity, mortality and cost utilisation. Poor compliance has been reported as the most common cause of nonresponse to medication, with evidence to show that patients who adhere to treatment recommendations have better health outcomes than those who do not adhere, even when taking a placebo. Evidence-based practice guidelines, founded on clinical, behavioural and educational concepts, provide a means of measuring outcomes related to health status, patient satisfaction and cost-benefit issues, and may help to ensure that responsibility for compliance is shared between the clinician and the patient.
Humans↗
Patient compliance with inhaled medication: does combining beta-agonists with corticosteroids improve compliance?
Patient compliance with an inhaled corticosteroid may be greater if it is combined with a beta-agonist. This study compared compliance with an inhaled corticosteroid (budesonide), and a short-acting inhaled beta-agonist (terbutaline sulphate), and a Turbuhaler inhaler containing a combination of the two drugs. In an open, multicentre, parallel group study 102 asthmatic patients were randomly divided into two groups, either receiving the two drugs in separate Turbuhalers or combined into one Turbuhaler. A twice daily regimen was prescribed and a preweighed metered-dose inhaler (MDI) of salbutamol was provided for rescue use. Compliance was measured using the Turbuhaler Inhalation Computer (TIC), which recorded the time and date of each inhalation over a 12 week period. Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) measurements were carried out at week 0, 6 and 12. Results from 72 patients were analysed. The average compliance was 60-70%. Treatment was taken as prescribed on 30-40% of the study days, and over-usage occurred on less than 10% of days. Only 15% of patients took the drugs as prescribed for more than 80% of the days. Compliance was no greater in patients using the combined inhalers. Other ways of improving patient self-management need further investigation.
Administration, Inhalation↗
Taking your medicine: relational steps to improving patient compliance.
Patient non-compliance with physicians' instructions is a major problem that costs billions of dollars each year. This study supports a significant role for communication, both as a form of information exchange and social support, and participative decision-making in improving patient compliance. These results, based on structural equation modeling, also support the interaction of communication and participative decision-making positively affecting compliance. Results suggest that one-way communication from physician to patient and patient education will not solve compliance problems by themselves. Instead the solution revolves around open, bi-directional information exchange, active listening by both parties, and truly informed consent on the part of patients.
Adult↗
[How to enhance patient compliance?].
Patient non-compliance with medication leads to disadvantageous medical consequences and contributes to the rise of expenses of the health care system. Nevertheless, patient non-compliance is an ubiquitous problem. In such circumstances there is a need to apply activities leading to the enhancement of patient compliance. The useful methods are described in this paper. Most of them is widely available and may be applied by physicians, particularly by general practitioners.
Health Promotion↗
Docs and delivery systems can work together to improve patient compliance.
Patients who don't comply with medication regimens or behavior modification recommendations are bound to give your DM programs a case of frustration. Two national efforts aimed at improving compliance will help you identify the barriers that keep patients from following instructions and show you ways to break them down.
Counseling↗
Strategies for enhancing patient compliance.
Patient noncompliance is a substantial obstacle to the achievement of therapeutic goals. This paper reviews a number of practical interventions with demonstrated efficacy in enhancing patient adherence, including (1) improving patients' levels of information concerning the specifics of their regimens, reinforcing essential points with review, discussion, and written instruction, and emphasizing the importance of the therapeutic plan, (2) taking clinically appropriate steps to reduce the cost, complexity, duration, and amount of behavioral change required by the regimen and increasing the regimen's convenience through "tailoring" and other approaches, (3) obtaining a compliance-oriented history of the patient's prior experiences and present health beliefs and, where necessary, employing strategies to modify those perceptions likely to inhibit compliance, (4) improving levels of patient satisfaction, particularly with the provider-patient relationship, (5) arranging for the continued monitoring of the patient's subsequent compliance to treatment, (6) increasing staff awareness of the magnitude and determinants of the noncompliance phenomenon and attempting to develop an "active influence orientation" in each member of the health care team, (7) using such techniques as patient-provider contracts to involve the patient in therapeutic decisions and in the setting of treatment objectives and creating incentives (through rewards and reinforcements) for achieving these objectives, (8) arranging for as much continuity of provider (and other staff) as possible, (9) establishing methods of supervising the patient, including involvement of the patient's social support network, and (10) involving fully the assistance of all available health care providers, assigning specific roles and responsibilities for activities directed at improving adherence to treatment.
Attitude to Health↗
[Effects of TES program on exercise capacity, self-efficacy and patient compliance in patients with myocardial infarction].
PURPOSE: This study aimed to develop a TES program to improve exercise capacity to promote patient compliance to the prescribed exercise, and to test the feasibility of the program. METHOD: The 8-week TES program consisted of three components : exercise training, self-efficacy enhancement and social support. Using the matching of gender, age, and the left ventricular ejection fraction, thirty one subjects were consecutively assigned to either TES group (n=15, 52+7 years) or Control group (n=16, 58+11 years) 3 weeks after MI. With the exception of exercise compliance (only after the TES program), the exercise capacity and exercise self-efficacy were both measured both before and after the 8-week TES program. RESULT: The VO2peak (p=.043), anaerobic threshold (p=.023) and exercise duration (p=.015) improved in TES group compared to Control group after 8 weeks. The cardiac exercise self-efficacy (p=.036) was significantly higher in TES group than Control group. There was a significant increase of exercise compliance(p=.005) in TES group compared to Control group. CONCLUSION: The 8-week TES program improved the exercise capacity, exercise self-efficacy and exercise compliance. A appropriately implemented TES program in cardiovascular nursing practice may promote healthy behavioral modification and, therefore, contributing to reduce the risk of mortality and morbidity in MI patients.
English Abstract↗
Patient compliance an patient education: some fundamental issues.
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Patient Compliance↗
Effect of irbesartan monotherapy compared with ACE inhibitors and calcium-channel blockers on patient compliance in essential hypertension patients: a multicenter, open-labeled, three-armed study.
OBJECTIVES: This multicenter, three-armed, open-labeled study investigated patient compliance of patients receiving irbesartan, angiotensin-converting enzyme (ACE) inhibitors or calcium-channel blockers (CCB) for essential hypertension for a 6-month period. Patients were either newly diagnosed or switched from existing antihypertensive medication due to lack of efficacy or side-effects. METHODS: Patients were started monotherapy with irbesartan (n=377), ACE inhibitors (n=298) or CCB (n=308) and were reevaluated on 1st, 3rd, and 6th months of the treatment. The primary endpoint was patient compliance, assessed by proportion of patients who had taken their study medication every day. Efficacy was recorded as mean reductions in blood pressure and the proportion of patients whose blood pressure normalized. Tolerability was assessed by reported adverse events. RESULTS: Significantly more patients receiving irbesartan had complied with study medication after 3 and 6 months of treatment than ACE inhibitors or CCB. Significantly fewer patients receiving irbesartan needed to change their antihypertensive medication. All three study treatments exhibited similar efficacy profiles, but irbesartan had significantly less adverse events. CONCLUSIONS: This study demonstrated that patient compliance to irbesartan was significantly superior to other study treatments. Irbesartan is therefore a suitable first-line therapy for essential hypertension in everyday clinical practice.
Adult↗
Patient compliance among family practice patients.
OBJECTIVE: To document patient compliance and perceptions among family practice patients. DESIGN: A questionnaire-based survey of a convenience sample. PLACE AND DURATION OF STUDY: Family Practice Center of Aga Khan University Hospital, Karachi, Pakistan, between October 2003 and January 2004. SUBJECTS AND METHODS: Family practice patients were interviewed without systematic randomization. A questionnaire including data on demographic profile of the patient and compliance, was administered by the study investigators. Ethical requirement including the administration of written informed consent and confidentiality were ensured. SPSS computer software was used for data management. RESULTS: A total of 119 patients were interviewed, of which 86 (72%) were females. The mean age was 34.6 years. Thirty two (27%) of the respondents had graduate education. Forty three (36.1%) respondents had the last physician's visit within the previous two weeks. Recommendations made at the previous physician's visit were followed in 170 (79.8%) cases. Desire to get better was reported by 172 (79.6%) respondents, as a reason for compliance. In patient's view, being polite, friendly and kind to the patient and explaining treatment to the patient, could improve patient compliance. CONCLUSION: There is a need to have a broad based approach to improve patient compliance including patient education, following principles of good clinical practice and giving due consideration to financial costs. We recommend further research and debate on the important issue of patient compliance.
Adult↗
Patient compliance: a determinant of patient satisfaction?
Recent studies have shown that there is a distinct relationship between patient satisfaction and patient compliance in orthodontic treatment. The aim of this study was to investigate whether patient compliance, as noticed and recorded by the orthodontist during treatment, can be used as a determinant of patient's satisfaction in the long run. Documentation of 100 patients who completed active orthodontic treatment in the year 2000 at the Academic Centre of Dentistry Amsterdam was analyzed, and compliance scores for patients were computed. Three years after completion of active orthodontic treatment, a questionnaire about satisfaction was sent to all subjects. Items were divided over six subscales on the basis of item content. Compliance and satisfaction scores of both sexes were compared, and correlations between compliance and satisfaction were explored. Regression analyses were done to examine the predictive value of sex and compliance on patient satisfaction. No significant correlations between compliance and satisfaction scores were found. Sex, but not compliance, predicted the patient's satisfaction with the doctor-patient relationship and the situational aspects of the treatment. Compliance, as noticed and recorded by the orthodontist during treatment, is not a decisive determinant of patient satisfaction in the long run. Sex, however, is a predictor of patient satisfaction with regard to the doctor-patient relationship and the situational aspects of the orthodontic treatment.
Adolescent↗
Strategies for improving patient compliance.
Achieving patient compliance in taking prescribed medications is a formidable challenge for all clinicians. As PAs, we have daily opportunities to communicate with patients and improve their compliance. An office-based compliance program, combining patient education and behavior-modification components, can be beneficial in this regard. Strategies for improving compliance include giving clear, concise, and logical instructions in familiar language, adapting drug regimens to daily routines, eliciting patient participation through self-monitoring, and providing educational materials that promote overall good health in connection with medical treatment.
Communication Barriers↗
Vantage point. Teaching patient compliance.
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Patient Compliance↗
Enhancing patient compliance: a guide for nurses. To increase their patients' compliance with health recommendations, nurses need a framework.
The cases studied demonstrated that an interactive patient education approach, incorporating many of the factors that influence compliance, is successful in influencing patients to follow health care advice. This approach requires a consistent, concerned, nonjudgmental, supportive relationship with the patient. Assessing each area of health behavior the patient is being asked to change, and the effects of these changes, is an essential first step. Self-care deficits, such as low self-esteem and denial, are obstacles to compliance and thus require nursing intervention. Nursing expertise in providing specific individualized information and a step-by-step plan with ample reenforcement and support is critical. Behavioral strategies are helpful for those who are unable to change with information alone. Finally, long-term nursing follow-up is essential for patient compliance. Increased compliance will save health care dollars, and nurses facilitating this are a valuable asset. Hospital nurses, home health nurses, clinic nurses, and nurses practicing in advanced practice--such as clinical specialists and nurse practitioners--would be ideal to facilitate long-term follow-up. Some impact can be made by nurses no matter what the setting.
Adult↗
[Patient compliance of hypertensive patients in the physician's practice].
Compliance of hypertensive patients is primarily estimated in participating patients in clinical trials. Although compliance is overestimated by pill-counting, this technique is most frequently used. 389 Austrian general practitioners studied compliance in 945 hypertensives, using the Medication Event Monitoring System. The patients were asked to take the ACE-inhibitor Cilacapril once a day between 7.00 a.m. and 9.00 a.m. Each package opening was registered by a microprocessor located in the cover of the drug vial. In this study it turned out that only 1.3% of the patients did open their vials between 7.00 a.m. and 9.00 a.m. 2 thirds of the patients actually took less than 80% and 36% less than half of the prescribed medication. There was no correlation between compliance and sex, age, smoking habits, tolerance or duration of hypertension. Even fall in blood pressure was the same in compliant and non compliant patients. The conclusion is that compliance is bad in a general practitioner setting and further more that casual readings as performed in this study are an insufficient tool to judge efficacy.
Antihypertensive Agents↗
Patient compliance and therapeutic coverage: amlodipine versus nifedipine SR in the treatment of hypertension and angina: interim results. Steering Committee and Cardiologists and General Practitioners involved in the Belgium Multicentre Study on Patient Compliance.
An interim analysis of patient compliance is reported in 234 hypertension outpatients who were entered into a large-scale, open, crossover, comparative study between a new-generation calcium antagonist, amlodipine (5 mg, once daily), and nifedipine SR (20 mg, twice daily). An analysis was also performed on 84 outpatients with stable angina pectoris, who were included in an open, parallel study and received the same dosing regimen of either amlodipine or nifedipine SR as the patients in the hypertension arm of the study. In the hypertensive patients, there were significant differences in favor of amlodipine, using all four methods to assess patient compliance. In the angina patients, a significant difference between the groups in favor of amlodipine was only found using the "correct dosing" and the "timing compliance" methods. With the traditional pill-counting and also the "taking compliance" methods, there was no observed difference in compliance between the two groups. It was concluded that, in terms of patient compliance, once-daily amlodipine was markedly superior to twice-daily nifedipine in the crossover study involving the hypertension patients. Amlodipine was also better tolerated than nifedipine. In the angina arm of the study, patient compliance was again better with amlodipine than with nifedipine, but there was no difference observed in the levels of tolerance between the two therapies.
Amlodipine↗