For Noncompliant Patients, A Fix That Works
For Noncompliant Patients, a Fix That Works An Approach to Improving Compliance That Works A growing number of doctors have been using a special technique that gets superior compliance from patients. Here are some of the enviable results: In a study on medication compliance in 50 people with severe asthma, those who received this technique refilled their prescriptions for inhaled corticosteroids 21% more often in a year, compared with those who received usual care.[ 1 ] In a study of 217 obese women with type 2 diabetes, those who received this technique lost significantly more weight than those who didn't.[ 2 ] They also showed significant reductions in their A1c levels at 6 months. In a study of more than 2500 teenagers who smoked, those who received it showed significantly higher abstinence rates than those who didn't after 2 years.[ 3 ] It's a way of talking with patients that's designed to elicit their barriers to compliance and assist them in overcoming those barriers. Studies show that doctors using this method of interaction can often work wonders. They can get people with chronic conditions who consistently don't take their medications as their doctors prescribe -- or follow their doctors' advice on losing weight, reducing alcohol consumption, stopping smoking, or quitting other unhealthy habits -- to begin to take constructive action on their own behalf. Called "motivational interviewing," the method was first introduced in 1983 by a psychologist whose goal was to change behavior in people who were alcoholics and drug addicts.[ 4 ] The idea was to get them -- by showing empathy, being nonjudgmental, and posing simple but strategic questions -- to reveal why they resisted behavior change and what would motivate them to change so that they could begin to addres Continue reading >>
- It’s horrible, deadly — and insanely easy to fix. But America’s troubles with food insecurity means millions are closer to the scurvy zone than we admit.
- Just A Single Powerful Kitchen Spice Fix Obesity, Insomnia, Anemia, Diabetes, Acidity, Intestinal Worms, Detox Liver And…
- The 30-minute op that can save diabetes patients from losing a leg - so why aren't more patients being offered this?
Poor Medication Adherence In Type 2 Diabetes: Recognizing The Scope Of The Problem And Its Key Contributors
Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors At least 45% of patients with type 2 diabetes (T2D) fail to achieve adequate glycemic control (HbA1c <7%). One of the major contributing factors is poor medication adherence. Poor medication adherence in T2D is well documented to be very common and is associated with inadequate glycemic control; increased morbidity and mortality; and increased costs of outpatient care, emergency room visits, hospitalization, and managing complications of diabetes. Poor medication adherence is linked to key nonpatient factors (eg, lack of integrated care in many health care systems and clinical inertia among health care professionals), patient demographic factors (eg, young age, low education level, and low income level), critical patient beliefs about their medications (eg, perceived treatment inefficacy), and perceived patient burden regarding obtaining and taking their medications (eg, treatment complexity, out-of-pocket costs, and hypoglycemia). Specific barriers to medication adherence in T2D, especially those that are potentially modifiable, need to be more clearly identified; strategies that target poor adherence should focus on reducing medication burden and addressing negative m Continue reading >>
Patients Perspectives On Noncompliance With Diabetic Retinopathy Standard Of Care Guidelines - Sciencedirect
Volume 75, Issue 11 , November 2004, Pages 709-716 Get rights and content Periodic dilated eye examinations are recommended by the American Optometric Association, American Academy of Ophthalmology, and American Diabetes Association to detect sight-threatening conditions in diabetic patients. However, many patients with diabetes do not receive this recommended eye care and there is limited research to explain why. The objective of this study was to determine reasons some diabetic patients do not receive a dilated eye examination at least every year. A chart review identified patients at The Ohio State University College of Optometry who had not been examined for more than a year, but less than two years. A telephone interview was attempted for all subjects. Of 100 eligible subjects, 43 completed the telephone interview. The reasons patients with diabetes did not return for a recommended dilated eye examination included transfer of care to another eye doctor, limited personal mobility due to poor overall health, last examination at a homeless clinic, self-reported lack of insurance, and self-reported apathy. Strategies to improve compliance of patients with diabetes should include reaching patients of low socioeconomic status and those institutionalized for poor overall health. Improved compliance may also come by encouraging patients to use medical insurance for eye examinations and using patient recall systems. Continue reading >>
- Evaluating Adherence to Dilated Eye Examination Recommendations Among Patients with Diabetes, Combined with Patient and Provider Perspectives
- Glibenclamide and metfoRmin versus stAndard care in gEstational diabeteS (GRACES): a feasibility open label randomised trial
- Exercise and Glucose Metabolism in Persons with Diabetes Mellitus: Perspectives on the Role for Continuous Glucose Monitoring
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 >>
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 >>
Non-compliance Vs. Diabetes Self Care: Are We Still Playing A Blame Game?
Non-compliance vs. diabetes self care: Are we still playing a blame game? In 1993, I published an article entitled Is non-compliance a dirty word? in The Diabetes Educator in which I expressed my sadness that people with diabetes were actually getting blamed by their health care providers for not following treatment advice (1). I suggested that the patients failure might really be a failure in the partnership (or lack thereof) between patient and provider. Fifteen years ago, I challenged diabetes educators to work together with medical practitioners to change noncompliance from a dirty word to a rare occurrence. So how are we doing today? The diabetes lingo has gone from non-compliance to non-adherence to the inability to perform self-care, all to describe whether or not a patient with diabetes is following their prescribed regimen. No matter what we call it, the outcome is the same. The patient is not doing what we told them to do. The result can be the onset and progression of the complications of diabetes that we all know and dread. The consequences all belong to the patient, not us. My question to my fellow diabetes educators is: Whose regimen is it anyway? Are we taking the time to ask the patient how they choose to manage their diabetes? What are their goals? Have we presented both the benefits and the costs (time, money and energy) of the treatment we are recommending? Does the patient know how to follow their regimen safely and comfortably? Until we do this, the patient is not ready to be independent and perform self-care. Several years ago I was asked to see a new patient as a favor to a former colleague. She was in tears describing how her husband was not taking care of his type 2 diabetes and she feared he would develop serious complications or worse. Franks Continue reading >>
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 >>
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 >>
Treatment Non-compliance And Mortality In Patients With Type 1 Diabetes
Treatment Non-compliance and Mortality in Patients with Type 1 Diabetes The extent to which patients are compliant with their type 1 diabetes treatment may have an effect on their all-cause mortality risk, according to the results of a study. Researchers at Cardiff University in the United Kingdom recently explored the effects of non-compliance (both medication non-compliance, and not showing up for scheduled medical appointments) on all-cause mortality rates in people living with type 1 diabetes. Their study, The impact of treatment non-compliance on mortality in people with type 1 diabetes, was published online ahead of print in November 2012. It appears in the Journal of Diabetes and its Complications. The researchers relied on data from The Health Improvement Network (THIN) database which contains information on patients seen at more than 350 facilities in the United Kingdom. Only participants who had diagnostic codes that indicated type 1 diabetes were included in the study. Treatment non-compliance was defined as missing medications or missing one or more scheduled medical appointments. The results of the study showed that 29.4% of the patients included in the study (867 out of 2,946) were non-compliant in their medication regimen, or missed medical appointments during the 30-month assessment period. After controlling for confounding factors, the researchers found that patients who were not compliant with their treatment had a mortality rate of 1.462 (95% CI 0.954-2.205), and that treatment non-compliance was linked to a heightened risk of all-cause mortality in these patients. The researchers conclude that their findings demonstrate an association between all-cause mortality and treatment non-compliance (both medication non-compliance and missing scheduled medic Continue reading >>
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 >>
- The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus
- Improved pregnancy outcomes in women with type 1 and type 2 diabetes but substantial clinic-to-clinic variations: a prospective nationwide study
- Early Glycemic Control and Magnitude of HbA1c Reduction Predict Cardiovascular Events and Mortality: Population-Based Cohort Study of 24,752 Metformin Initiators
Addressing Noncompliance In Latino Patients With Diabetes
Addressing Noncompliance in Latino Patients With Diabetes Authors: News Author: Kristin Jenkins; CME Author: Laurie Barclay, MD This article is intended for primary care clinicians, diabetologists/endocrinologists, nurses, pharmacists, public health officials, and other members of the healthcare team involved in the care of Latino patients with type 2 diabetes. The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care. Upon completion of this activity, participants will be able to: Determine the association of patient race/ethnicity, preferred language, and physician language concordance with patient adherence to newly prescribed diabetes medications, based on an observational study Identify changes in risk factor control among limited English proficiency Latino patients with diabetes who switched from English-speaking to Spanish-speaking physicians or vice versa, based on a prepost, difference-in-differences study As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content. Disclosure: Kristin Jenkins has disclosed no relevant financial relationships. Disclosure: Robert Morris, PharmD Continue reading >>
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 >>
The Art Of Compliance
Twitter summary: Kerri tackles the tricky question of compliance is it offensive, out-dated, or misunderstood? Our readers weigh in. compliance (noun) - the act or process of doing what you have been asked or ordered to do : the act or process of complying The word compliance, by definition, does a great job of putting my actions into specific categories. Am I doing what I was told, or not? Am I counting my carbs to the gram and calculating my insulin doses accordingly? Or am I relying too heavily on estimations? Its a word that comes with a simple definition, but with many connotations, especially in the world of diabetes care. Compliance, for so many, can be a word loaded with shame, finger-pointing, and judgment. If my doctor calls me out for a lack of compliance, I feel terrible for disappointing her and not meeting her expectations. But mostly I feel discouraged with myself for my inability to follow directions. What makes it so hard to do whats necessary the multiple glucose checks per day, the healthiest diet, the regular exercise? And why does this one word seem to make or break a mindset for so many? Over the last almost-three decades, Ive had some very compliant pockets of time with my diabetes duties (e.g.. pregnancy, where I followed every rule to the absolute best of my ability). Ive also been decidedly non-compliant/apathetic at other times (e.g. during my parents divorce, where I barely tended to my diabetes needs at all). During the tougher times, words like compliant werent said out loud during my endocrinologist appointments. When my labwork and logbooks showed lots of out-of-range results, my endo didnt stamp my file with a big NON-COMPLIANT mark that was visible to me, even though there were several visits where the uncontrolled box was marked, or t Continue reading >>
Non-compliance With Treatment Regimens Among Clients With Diabetes Mellitus In University Of Maiduguri Teaching Hospital, North-eastern Nigeria
Journal of Research in Nursing and Midwifery (JRNM) (ISSN: 2315-568) Vol. 5(1) pp. 011-020, January, 2016 Available online Copyright 2016 International Research Journals Non-compliance with treatment regimens among clients with diabetes mellitus in university of Maiduguri 1Chutiyami Muhammad, 2Umar N Jibril, 3Salihu Dauda* 1Department of Nursing Services, Yobe State Hospitals Management Board, Nigeria 2Department of Nursing Science, University of Ilorin, Nigeria 3Department of Nursing Services, Yobe State Hospitals Management Board, Nigeria Corresponding authors E-mail: [email protected], +447443076385 This study investigates into factors responsible for non-compliance of treatment regimens among clients with diabetes mellitus in University of Maiduguri Teaching Hospital (UMTH), Borno State, Nigeria. A descriptive study design was adopted. 135 clients were sampled using a convenient sampling technique. A structured questionnaire was administered to 135 clients, and analysis was based on 125 clients that participated fully in the study. The instruments sought information on socio- demographic, knowledge and attitude towards compliance and factors responsible for non-compliance to diabetic treatment regimen. Null hypotheses were set and tested using chi-square () at 0.05 level of significance. The result showed that 57.6% of clients opined that non-compliance to treatment regimens was as a result of high cost of drug, while, lack of family support and poor attitude of health personnel was expressed by 37.6% and 51.2% of clients respectively. The study concluded that financial, family support and poor attitude of health care personnel which hindered clients compliance to diabetes mellitus treatment regimen be remedy, thus recommendations were made to enhance compliance Continue reading >>
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 >>
