Friday, 15 May 2015

HEALTHY LIVING - Features of adherence to medical regimes

REASONS FOR NON-ADHERENCE

Non-adherence can include changing the frequency or dosage of medicines, as well as neglecting to follow agreed actions such as exercise or stopping smoking. Reasons for non-adherence tend to come under two categories: intentional non-adherence and unintentional non-adherence. Unintentional non-adherence features reasons such as forgetfulness, inability to pay, and confusion, which meant that despite wanting to adhere, they were unable to. Intentional non-adherence occurs when there is a conscious decision not to follow advice, and is best understood in terms of perceptual factors such as believing that the medicine won’t work or is against their ethics or practical factors, such as the side-effects the medicine produces.

STUDY: Bulpitt et al. (1988)

Aim: Bulpitt et al. conducted a review article study on non-adherence to taking medication to regulate high blood pressure (hypertension).

Procedure: Various pieces of research were looked at to identify problems with taking drugs for high blood pressure. Both physical and psychological side effects were looked at, including problems at work and the effects on physical well-being.

Findings: The study found that anti-hypertension medication had many side effects including sleepiness, dizziness lack of sexual functioning, and weakened cognitive functioning.

Curb et al.’s study that 8% of males discontinued treatment due to sexual problems, whilst the medical research council found that 15% withdrew due to side effects.

Conclusions: It was concluded that when side effects outweighed the benefits of treating a mainly asymptomatic (an illness that has no obvious symptoms) problem such as hypertension, there is less likelihood of the patients adhering to their treatment.




MEASURES OF NON-ADHERENCE

There are various ways in which it has been proposed that adherence can be measured: using self-report, looking at the therapeutic outcome (did the patient get better?), asking the doctor, counting pills and bottles, mechanical methods (such as the track cap) and biochemical tests (such as blood and urine tests). However, none of these methods are without their faults.

STUDY: Lustman (2000) Using physiological measures of assessing adherence to medication and the treatment of depression in diabetics.

Aim: To assess the effectiveness of fluoxetine as treatment for depression in diabetics by measuring blood sugar levels.

Sample: A self-selected sample of 60 diabetic volunteers with depression was involved

Method: A laboratory experiment, using a double blind technique. All were screened for depression and randomly assigned to two groups (the group who would take the drug, and one who would take the placebo).
Participants were given daily doses of the medication for 8 weeks, and then re-assessed for depression and their adherence to their medical regimen through measuring blood sugar levels.

Findings:
The results showed that reduction of depression was significantly greater in the experimental group than the control group, and that these patients also had nearer normal blood sugar levels, which indicated improved adherence.

Conclusions: The conclusion from this research is that physiological tests were an effective method of measuring adherence, and that reduced depression may improve adherence in diabetic patients.




IMPROVING ADHERENCE USING BEHAVIOURAL MEASURES

Sometimes, non-adherence to medical regimen is not particularly serious, as sometimes symptoms and illnesses clear up by themselves. However, non-adherence can prove fatal. Potentially the most useful psychological standpoint in terms of a perspective or approach to non-adherence is the behavioural perspective, as it is a practical ans easy to implement.

STUDY: Watt et al. (2003)



Aim: Previous research had suggested that non-adherence in children with asthma could be due to boredom, apathy and forgetfulness. This study aimed to see if using a Funhaler instead of a regular inhaler could improve children’s adherence to taking asthma medication.

Sample: 32 asthmatic children with a mean age of 3.2 years, who had been prescribed drugs taken via an inhaler, were involved in the study.

Method: Parental consent was gained. The method was a field experiment using a repeated measures design, assessed through self-report. The independent variable was whether the child used the inhaler or Funhaler, and the dependent variable was the level of adherence to taking their asthma medication.

Procedure: For the first week, children used regular inhalers, and in the second week the Funhaler was used – a device which incorporates features to distract the child from the drug delivery and reinforces the use of the Funhaler, such as a spinner and a whistle which work best when the deep breathing required for effective drug delivery is used. After each week, the parents completed a questionnaire on adherence.

Results: The results were that 38% more parents reported higher adherence in the children when using the Funhaler, and thus it was concluded that making a medical regimen fun can improve adherence in children.


No comments:

Post a Comment