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Effects Of Non Compliance With Diabetes

Effect Of Treatment Non-compliance On Mortality In Patients With Type 1 Diabetes

Effect Of Treatment Non-compliance On Mortality In Patients With Type 1 Diabetes

This study aimed to determine the effect of treatment non-compliance on mortality rates in type 1 diabetes patients. Results showed that mortality was higher in patients who did not follow the prescribed treatment. Approximately 10% of all diabetes mellitus patients have type 1 diabetes as a result of a complete lack of insulin. Insulin is a hormone that is responsible for the regulation of blood sugar levels. Increased blood sugar levels damage body organs which in turn leads to complications such as coronary heart diseases and stroke. People diagnosed with type 1 diabetes are most often managed by insulin therapy (daily injections or use of an insulin pump). Patients with type 1 diabetes need insulin to survive and to prevent complications. Treatment compliance and regular follow-up are essential for the adequate management of diabetes. The present study assessed medication compliance and clinic attendance of patients with type 1 diabetes. Patient data was collected from The Health Improvement Network (THIN) database that employs what is called the Read coding system to record diagnoses and treatment related procedures. Of the 2946 patients included in the study, 867 had a record of treatment non-complicance. Patients who had missed their follow up visits were also more likely to be non-compliant to treatment. The study established that treatment non-compliance was associated with increased overall mortality. In summary, results suggest that mortality is higher in patients who do not follow the prescribed type 1 diabetes treatment. This study is limited by the fact that the use of Read codes is subject to the health care provider's assessment of the patient. The accuracy and consistency of such reporting are not clearly defined. Further research is required to determ Continue reading >>

Five Reasons Diabetic Patients Dont Adhere

Five Reasons Diabetic Patients Dont Adhere

Five reasons diabetic patients dont adhere Diabetes is a silent diseasemost of these patients feel fine, even if their sugar levels are dangerously high. Because they dont feel ill, many diabetic patients arent motivated to change their lifestyles or follow prescribed medical treatment. In fact, as few as 60% of patients with type 2 diabetes take prescribed medications, according to a study in the American Journal of Managed Care. Another study, in Diabetes Therapy, showed that less than 50% of diabetic patients achieve recommended glycemic goals. Furthermore, direct risk reduction for diabetes-related kidney disease, stroke, heart disease, and amputation were estimated for 100% compliance with diabetes treatment , as reported in a study in Innovations in Pharmacy. Risk, case, and yearly cost reduction calculated for 100% compliance with diabetes treatment were 13.6%, 0.9 million, and $9.3 billion, respectively. Given this, its obvious that adhering to treatment protocols can significantly benefit diabetes patients. So how can providerswho are ultimately responsible for motivating patients to improve complianceachieve the goal of better compliance among diabetic patients? Here, experts offer solutions for some common noncompliance issues. #1. Failure to adhere to treatment recommendations First and foremost, patients need to understand how the long-term implications of not taking care of their diabetes. Educating patients and their families about what diabetes does to the body, and how medication counters those effects, is critical to inciting behavior change, says Diana OKeefe, RN, CDTC, CDE, clinical coordinator, Diabetes and Endocrine Institute, Morristown Medical Center, Morristown, New Jersey. Serge Jabbour, MD, FACP, FACE, professor of medicine and director, Divi Continue reading >>

Are You A Non-compliant Diabetes Patient?

Are You A Non-compliant Diabetes Patient?

Are You a Non-Compliant Diabetes Patient? I have never met a person with diabetes who doesnt want to live a long and healthy life. However, people with diabetes (PWD) who dont have perfect glucose control or dont follow the exact instructions given to them by their healthcare providers (HCP) are often labeled as non-compliant. I see this all the time in our hospital with the medical students, residents, endocrine fellows, dieticians, CDEs and other faculty and staff. Once a PWD is labeled as non-compliant in the medical records, anyone who reads the note in preparation for a future meeting or consultation has already developed a preconceived notion that this person is a bad patient and doesnt follow the rules. It is a common situation that is pervasive among healthcare professionals in the community and is proven difficult to change or reverse. It also poisons the doctor-patient relationship, which I feel is extremely important for long-term success and satisfaction on both sides of the aisle! Why is it that so many PWD have less than ideal diabetes control and are labeled non-compliant? There are many diverse reasons, ranging from emotional, financial and physical barriers for the patient to uninformed and ignorant healthcare providers and, also, limited access to the best therapies currently available for many, many patients. The non-compliant label also stems from recent information that has emerged from very large databases (administrative claims and pharmacy refill records from large healthcare institutions) that people with type 2 diabetes apparently are not taking or refilling their medications regularly. According to these very accurate sources of prescription and refill information, a PWD is labeled non-adherent if they do not have medication in their possessi Continue reading >>

Glycemic Control And Medication Compliance In Diabetic Patients In A Pharmacist-managed Clinic In Hong Kong

Glycemic Control And Medication Compliance In Diabetic Patients In A Pharmacist-managed Clinic In Hong Kong

Medication noncompliance has a significant impact on morbidity, mortality, and quality of life in diabetic patients.[ 9 , 10 , 11 ] Problems with compliance may be related to patient demographics, the complexity of the drug regimen, dosage frequency, adverse effects, or some combination of these. The percentage of noncompliant patients was similar between the sexes in this study. However, patients with more education appeared to have better compliance than those with less education. It is commonly believed that elderly patients are less adherent to therapy because of declining cognitive function. This was not the case in this study. There are two possible explanations for this. First, older patients are more likely to have disease progression, leading to increased awareness of the illnesses and better motivation to comply with treatment. Second, older patients in Hong Kong often have support from family members or caretakers. During treatment, diabetic patients may not always understand their disease, and they may forget or misunderstand the instructions given by physicians and pharmacists. Some patients in the study group adjusted the dosage of their medications according to the severity of their hyperglycemic symptoms. Some patients did not even know the purpose of the drugs, while others took their medications at inappropriate times (such as, in the case of acarbose, long before meals). Enhancing patients' medication knowledge could improve compliance. In a study by Raji et al.,[ 12 ] 106 patients with HbA1c concentrations greater than 8.5% were randomly assigned to either intensive or passive education. Patients from both groups were found to have substantial improvement in HbA1c levels; thus, an educational intervention was effective, regardless of its intensity. Continue reading >>

Poor Compliance:

Poor Compliance:

Treatment regimens are only effective if the patient is willing to follow the plan. Compliance, the extent to which a patient adheres to a treatment regimen, primarily involves following the medication instructions, but it also can include lifestyle modifications, as well as keeping follow-up medical appointments?in general, it means overall participation in the treatment plan. Noncompliance may lead to relapse, aggravation of the disease state, hospitalization, escalating health care costs, and even death. In patients suffering from emotional disorders, noncompli-ance may result in serious setbacks to the progress they have already achieved on a regimen, whereas patients on antihyper-tensive medication may increase the risk of stroke and cardiovascular disease. Pharmacists can have a major impact on compliance rates. This article outlines the reasons behind noncompli-ance and provides 4 strategies for improving compliance. Noncompliance may be difficult to detect or address. Elderly patients and teenagers have higher rates of noncom-pliance than other segments of the population. Generally speaking, patients often lack enough information about their disease state or medication; they may have physical or functional impairments such as poor eyesight; or barriers may exist relating to attitude, such as personal values and culture. Factors leading to noncompliance are numerous (Table), and some of the major reasons for patient noncompliance are outlined here. It is understandably difficult for patients to follow a treatment that produces discomfort. Certain adverse effects associated with a class of drugs must be dealt with on a case-by-case basis. Many side effects subside with continued use of the medication, but it may take time for a patient to overcome this barrier. C Continue reading >>

Compliance Of Diabetic Patients With The Prescribed Clinical Regimen Attyia Aa, El Bahnasy Re, Abu Salem Me, Al-batanony Ma, Ahamed Ar - Menoufia Med J

Compliance Of Diabetic Patients With The Prescribed Clinical Regimen Attyia Aa, El Bahnasy Re, Abu Salem Me, Al-batanony Ma, Ahamed Ar - Menoufia Med J

This study aimed at studying the prevalence of noncompliance among diabetic patients in Gharbia governorate in Egypt as well its causes, its effect on glycemic control, and factors affecting it. There is growing evidence suggesting that because of the alarmingly low rates of compliance, increasing the effectiveness of compliance interventions may have a great impact on the health of the population. Promotion of therapeutic compliance is considered an integral component of patient care. It has been shown that despite effective methods of treatment, many diabetic patients fail to achieve satisfactory glycemic control, which leads to accelerated development of complications and increased mortality. A total of 339 diabetic patients who fulfilled the inclusion criteria were recruited in the present study. Compliance to treatment was evaluated during patients visits to health units in Gharbia governorate. Medication compliance was assessed during a personal interview with each patient using a multiple-choice questionnaire. Blood samples were obtained for measurement of glycated hemoglobin (HbA1c). In the study population, the compliance rates were observed to be suboptimal. The most important social factors that significantly affected compliance rates included age, income, and educational level. Among the factors that significantly affected compliance rates were duration of treatment, presence of diseases other than diabetes, and the number of prescribed drugs. Another factor that played an important role was diabetes care costs. The most common reasons for low rates of compliance were forgetfulness and high cost of treatment. An improvement in the compliance level may be achieved through improvement of patients economic levels as well as reduction in the cost of medication. Continue reading >>

Recommendations For Improving Adherence To Type 2 Diabetes Mellitus Therapy-focus On Optimizing Oral And Non-insulin Therapies

Recommendations For Improving Adherence To Type 2 Diabetes Mellitus Therapy-focus On Optimizing Oral And Non-insulin Therapies

Recommendations for Improving Adherence to Type 2 Diabetes Mellitus Therapy-Focus on Optimizing Oral and Non-Insulin Therapies Supplements > Improving Adherence in the Treatment of Type 2 Diabetes Mellitus: Opportunities for Managed Care Published on: April 20, 2012 Recommendations for Improving Adherence to Type 2 Diabetes Mellitus Therapy-Focus on Optimizing Oral and Non-Insulin Therapies Adherence to therapy in patients with type 2 diabetes mellitus is contingent upon a number of variables, including variables specific to the patient, to the provider, and to the treatment. While treatment selection will involve consideration to maximize effectiveness and minimize side effects, the physician must also take into account the priorities and preferences of each individual patient. For some patients, the risk of weight gain may exert a significant influence on adherence, while for others the risk of hypoglycemia or the cost of medications may be more important factors. It is incumbent upon physicians to discuss these issues with patients and to develop a patient-centric treatment plan to achieve optimal adherence and therapeutic outcomes. The nature of the clinical setting can also influence the likelihood of patient adherence to treatment. A multidisciplinary team approach to diabetes management has been shown to improve outcomes and to have a neutral or beneficial effect on costs. The treatment plan itself plays an additional role in the likelihood of a patient adhering to treatment. Less complex treatment regimens with fewer pills are associated with higher rates of adherence, as are fixed-dose combinations for those patients requiring combination therapy. Frequency and timing of dosing are also important aspects of adherence, as once-daily dosing is associated with hi Continue reading >>

The Impact Of Treatment Non-compliance On Mortality In People With Type 1 Diabetes

The Impact Of Treatment Non-compliance On Mortality In People With Type 1 Diabetes

Objective: To determine the association between copayment, medication adherence and outcomes in patients with Heart failure (HF) and Diabetes Mellitus (DM).Methods: PubMed, Scopus and Cochrane databases were searched using combinations of four sets of key words for: drug cost sharing; resource use, health and economic outcomes; medication adherence; and chronic disease.Results: Thirty eight studies were included in the review. Concerning the direct effect of copayment changes on outcomes, the scarcity and diversity of data, does not allow us to reach a clear conclusion, although there is some evidence indicating that higher copayments may result in poorer health and economic outcomes. Seven and one studies evaluating the relationship between copayment and medication adherence in DM and HF population, respectively, demonstrated an inverse statistically significant association. All studies (29) examining the relationship between medication adherence and outcomes, revealed that increased adherence is associated with health benefits in both DM and HF patients. Finally, the majority of studies in both populations, showed that medication adherence was related to lower resource utilization which in turn may lead to lower total healthcare cost.Conclusion: The results of our systematic review imply that lower copayments may result in higher medication adherence, which in turn may lead to better health outcomes and lower total healthcare expenses. Future studies are recommended to reinforce these findings. Background: It is well recognised that management of young adults with type 1 diabetes (T1DM) poses difficult challenges for physicians and health care organisations as a whole. In Ireland and in particular the west of Ireland there has been little audit or research on young a Continue reading >>

Sade Pblica - Factors Associated With Therapy Noncompliance In Type-2 Diabetes Patients Factors Associated With Therapy Noncompliance In Type-2 Diabetes Patients

Sade Pblica - Factors Associated With Therapy Noncompliance In Type-2 Diabetes Patients Factors Associated With Therapy Noncompliance In Type-2 Diabetes Patients

Factors associated with therapy noncompliance in type-2 diabetes patients Frecuencia y factores asociados al incumplimiento teraputico en pacientes con diabetes mellitus tipo 2 Lizbeth Hernndez-Ronquillo, MDI; Jos Francisco Tllez-Zenteno, MScII; Juan Garduo-Espinosa, MScIII; Erick Gonzlez-Acevez, MDIII IInstituto Nacional de Perinatologa. Mxico, DF, Mxico IIInstituto Nacional de Ciencias Mdicas y Nutricin Salvador Zubirn. Grupo AFINES, Facultad de Medicina, Universidad Nacional Autnoma de Mxico, Mxico, DF, Mxico IIIInstituto Mexicano del Seguro Social, Mxico, DF, Mxico OBJECTIVE: To identify the frequency and factors associated with therapy noncompliance in type-2 diabetes mellitus patients. MATERIAL AND METHODS: 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. RESULTS: 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). CONCLUSIONS: The frequency of therapy noncompliance was very high, especially for diet and exercise. The English version of this paper is av Continue reading >>

Factors Contributing To Non-compliance Among Diabetics Attending Primary Health Centers In The Al Hasa District Of Saudi Arabia Khan Ar, Al-abdul Lateef Zn, Al Aithan Ma, Bu-khamseen Ma, Al Ibrahim I, Khan Sa - J Fam Community Med

Factors Contributing To Non-compliance Among Diabetics Attending Primary Health Centers In The Al Hasa District Of Saudi Arabia Khan Ar, Al-abdul Lateef Zn, Al Aithan Ma, Bu-khamseen Ma, Al Ibrahim I, Khan Sa - J Fam Community Med

Compliance in healthcare is defined as the extent to which a patient's behavior (in terms of taking medication, executing the lifestyle changes, undergoing medical tests or keeping appointments with the physicians) coincides with the healthcare provider's recommendations for health and medical advice. [1] Non-compliant patients are those whose health-seeking or maintenance behaviors lack congruence with the recommendations prescribed by a healthcare provider. [2] Patient non-compliance is a serious healthcare concern that poses a great challenge to the successful delivery of healthcare. This is widespread and has been reported from all over the world. [3] According to a study by the New England Health Care Institute, one-third to one-half of the American patients are non-compliant. [3] Patient non-compliance is not only limited to the failure to take medication , but also the failure to make lifestyle changes, undergo tests or keep appointments with physicians. The non-compliant patients especially with chronic diseases are more prone to encountering serious difficulties. [4] The rate of non-compliance in patients with chronic diseases in developed countries, on long-term treatment, is on the order of 50%This could be even higher in developing countries (WHO) [5] One study showed that while diabetic and cardiac patients who take medication correctly have a 7% death rate; for those who are non-compliant the death rate is 12%. In another study, the rate of non-compliance ranged between 16.7 and 80% among the patients suffering from tuberculosis, hypertension, asthma, diabetes, epilepsy, and congestive cardiac failure. [6] A compliance study conducted in Saudi Arabia for those on short-term medication found 67.8% compliance. However, compliance of patients tend to decreas Continue reading >>

The Impact Of Treatment Non-compliance On Mortality In People With Type 1 Diabetes

The Impact Of Treatment Non-compliance On Mortality In People With Type 1 Diabetes

To determine if a diagnostic record of poor treatment compliance (medication non-compliance and/or non-attendance at medical appointments) was associated with all-cause mortality in people with type 1 diabetes. This is an observational cohort study of data extracted from The Health Improvement Network (THIN) database, comprising data on patients served by over 350 primary care practices in the UK. Participants were included in the study if they had diagnostic codes indicative of type 1 diabetes. Treatment non-compliance was defined as missing one or more scheduled appointment, or one or more codes indicating medication non-compliance. Of 2946 patients with type 1 diabetes, 867 (29.4%) had a record of either appointment non-attendance or medication non-compliance in the 30month compliance assessment period. The crude, unadjusted mortality rate for those patients who were treatment non-compliant was 1.462 (95% CI 0.9542.205). Following adjustment for confounding factors, treatment non-compliance was associated with increased all-cause mortality (HR=1.642; 95% CI 1.0552.554). Treatment non-compliance was associated with increased all-cause mortality in patients with type 1 diabetes. Understanding and addressing factors that contribute to patient treatment non-compliance will be important in improving the life expectancy of patients with type 1 diabetes. Continue reading >>

Therapeutic Compliance: A Prospective Analysis Of Various Factors Involved In The Adherence Rate In Type 2 Diabetes - Em|consulte

Therapeutic Compliance: A Prospective Analysis Of Various Factors Involved In The Adherence Rate In Type 2 Diabetes - Em|consulte

Doi : DM-12-2006-32-6-1262-3636-101019-200520008 Therapeutic compliance: a prospective analysis of various factors involved in the adherence rate in type 2 diabetes Y Bezie[1], M Molina[1], N Hernandez[2], R Batista[1], S Niang[1], D Huet[2] [2]Diabetology and Endocrinology Department, Fondation Hpital Saint-Joseph, 185, rue R.Losserand, 75014 Paris, France. [1]Service de Pharmacie, Fondation Hpital Saint-Joseph, 185, rue R.Losserand, 75014 Paris, France. Observance thrapeutique: analyse prospective des diffrents facteurs impliqus dans l'observance du traitement du diabte de type2 Il est admis que l'observance mdicamenteuse est mdiocre lors de traitement des maladies chroniques. La dtermination des causes de non observance chez le patient diabtique est d'une aide prcieuse pour optimiser sa prise en charge thrapeutique. Le but de notre tude tait de dterminer les diffrents paramtres influenant l'observance mdicamenteuse dans le diabte de type2. L'observance au traitement a t value l'aide d'un questionnaire spcifique complt pour chaque patient lors de son hospitalisation dans le service de diabtologie d'un hpital franais de 450lits. Les facteurs valus portaient sur des donnes dmographiques de la population, le traitement utilis, et les donnes mdicales et biologiques. 94patients hospitaliss pour un diabte non contrl, gs de 41-89ans ont t tudis. Le taux de non observance trouv tait lev, 33 d'entres eux ne suivant pas rgulirement leur traitement. Les patients non observants (PNO) taient plus jeunes que les patients observants (PO) (56,51,1 vs. 65,512,5 ans; P0,0001) et caractriss par un niveau social infrieur. Les PNO prsentaient une dure de diabte plus courte et moins de complications macroangiographiques (6,9 vs. 33,3%; P=0,006). Le nombre de prises quotidiennes de mdicame Continue reading >>

Adherence (medicine)

Adherence (medicine)

This article is about following medical advice. For the physiological term, see Compliance (physiology) . For other uses, see Compliance . In medicine, compliance (also adherence, capacitance) describes the degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to other situations such as medical device use, self care , self-directed exercises, or therapy sessions. Both patient and health-care provider affect compliance, and a positive physician-patient relationship is the most important factor in improving compliance, [1] The cost of prescription medication also plays a major role. [2] Compliance rates may be overestimated in the medical literature, as compliance is often high in the setting of a formal clinical trial but drops off in a "real-world" setting. [3] Compliance can be confused with concordance, which is the process by which a patient and clinician make decisions together about treatment. [4] Worldwide, non-compliance is a major obstacle to the effective delivery of health care. 2003 estimates from the World Health Organization indicated that only about 50% of patients with chronic diseases living in developed countries follow treatment recommendations with particularly low rates of adherence to therapies for asthma , diabetes , and hypertension . [1] Major barriers to compliance are thought to include the complexity of modern medication regimens, poor "health literacy" and not understanding treatment benefits, occurrence of undiscussed side effects, poor treatment satisfaction, cost of prescription medicine, and poor communication or lack of trust between a patient and his or her health-care provider. [5] [6] [7] [8] Efforts to improve compliance have been aimed at simpli Continue reading >>

Why Are So Many Patients Noncompliant?

Why Are So Many Patients Noncompliant?

If you're baffled by how many of your patients, particularly those with chronic conditions, don't take their medications as prescribed -- if at all -- you're not alone. Doctors from coast to coast feel frustrated by the same thing. In 2011, Consumer Reports published a survey of 660 primary care physicians, "What Doctors Wish Their Patients Knew."[ 1 ] The number-one complaint by far: Patients didn't take the doctors' advice or otherwise follow treatment recommendations. "Most of the doctors we surveyed said it affected their ability to provide optimal care," the editors wrote.[ 1 ] "Thirty-seven percent said it did so 'a lot.'" In fact, the number of patients who are noncompliant has reached epidemic proportions, and doctors' inability to provide optimal care as a result has mushroomed into one of the most pressing problems in healthcare today. In the United States, some 3.8 billion prescriptions are written every year,[ 2 ] yet over 50% of them are taken incorrectly or not at all.[ 3 ] In a survey of 1000 patients, nearly 75% admitted to not always taking their medications as directed.[ 4 ] A study of over 75,000 commercially insured patients found that 30% failed to fill a new prescription, and new prescriptions for chronic conditions such as high blood pressure, diabetes, and high cholesterol were not filled 20%-22% of the time.[ 5 ] Even among chronically ill patients who regularly fill their prescriptions, only about half the doses taken are taken as their physicians intend.[ 6 ] Poor compliance accounts for 33%-69% of drug-related adverse events that result in hospital admissions.[ 3 ] Poor compliance with medication regimens is associated with up to 40% of nursing home admissions.[ 7 ] In a study of over 8400 senior health plan enrollees, only 1 in 3 of those w Continue reading >>

When The Patient Is Noncompliant

When The Patient Is Noncompliant

Well | When the Patient Is Noncompliant A 63-year-old man with hypertension, elevated cholesterol and diabetes, the intern recited as he presented the case to me in clinic. He read the list of seven medications the patient was prescribed. But hes noncompliant, the intern added. Noncompliant is doctor-shorthand for patients who dont take their medications or follow medical recommendations. Its one of those quasi-English-quasi-medical terms, loaded with implications and stereotypes. As soon as a patient is described as noncompliant, its as though a black mark is branded on the chart. This ones trouble, flashes into most doctors minds, even ones who dont want to think that way about their patients. And like the child in school who is tagged early on as a troublemaker, the label can stick around forever. Despite efforts to change the term to the slightly more accurate nonadherent, the word noncompliant remains firmly entrenched in the medical lexicon. No matter what its called, however, its an enormous problem. Experts estimate that some 50 percent of patients do not take their medicines as prescribed or follow doctors recommendations. When I address this issue with my patients, I like most doctors typically ask the basic question, Are you taking your medications? and then write down Yes or No. But a recent article in The Annals of Internal Medicine made me rethink that approach. Its an immense oversimplification to reduce compliance to whether or not a patient swallows a pill, says the author, Dr. John Steiner, a researcher at Kaiser Permanente in Colorado. To illustrate his point, he constructed a chart for a theoretical 67-year-old patient with diabetes, hypertension and high cholesterol and tabulated what it would take to be adherent with all medical recommendations. B Continue reading >>

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