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The Compliance Following Medical AdviceAmna Ahmad Aamna Haneef Ayesha Riaz Hira Nadeem Maliha Junaid 4426 4427 4433 4438 4441

Wuzna Harooon 4477 (Session: 2008 2012)

Health Psychology Instructors Name: Mrs. Amna Khhawar

Date of Submission: June 15th, 2012 Department of Psychology

Lahore College for Women University


1. Compliance: An Introduction..1 2. Predicting Patient Compliance 8 3. Factors Affecting Adherence.12 4. The Role of Knowledge in Health Professional-Patient Communication.23 5. Improving Adherence28


Compliance Following Medical Advice 1 Compliance: An Introduction

COMPLIANCE: AN INTRODUCTIONFor medical advice to benefit patients health, two requirements must be met. First, the advice must be valid Second, the patient must follow this good advice Both conditions are essential. Ill-founded advice that patients strictly follow may produce new health problems that lead to disastrous outcomes for the compliant patients. On the other hand, excellent advice is essentially worthless if patients do not follow it (Brannon & Feist, 2010).

Compliance: The term compliance refers to the extent to which the patients behavior (interms of taking medications, following diets, or executing other lifestyles changes) coincides with medical or health instructions or prescriptions (Carroll, 1992; Haynes 1979). Compliance is regarded as important primarily because following the recommendations of health professionals is considered essential to patient recovery (Ogden, 2010). However, Harvey (1988) has pointed out that there are considerable problems with the term compliance. The idea of physician authority and dominance and patient passivity and subservience is implicit in the concept of compliance. Trostle (1988), in a well argued analysis, proposed that compliance is in fact an ideology, derived from presumptions about the proper relationships between physicians and other health professionals on one hand, and the clients or patients on the other. From this perspective, compliance can be regarded as a generally unhelpful concept, save in reinforcing the authority and power of physician and other health care professionals (Carroll, 1992).

Compliance Following Medical Advice 2 Compliance: An Introduction

The Concept of AdherenceTraditionally, people in the medical profession have used the term compliance to refer patents behaviors that conform to physicians orders (Janet, 2001). But because of the term implies reluctant obedience, many health psychologists and some physicians advocate the use of other words, especially adherence.

Adherence refers to a persons ability and willingness to follow recommendedhealth practices (Brannon & Feist, 2010).

Brain Haynes (1979) defines adherence as the extent to which a persons behavior(in terms of taking medicines, follow diets, or executing lifestyle changes) coincides with medical or heath advice. The term compliance and adherence are the most frequently used terms and these two are sometimes used interchangeably.

Patients Non-Compliance and Compliance:Compliance is the patient following the advice given by the doctor. Failure to follow such advice is referred to as non-compliance (Broome, 1995). Non-compliance is not confined to patients. Health care professionals also show high levels of non-compliance with rules for optimal patient care (Ley, 1988). Patients non-compliance with advice has been defined in a variety of ways. Ley (1988) defines non-compliance for medication uptake as:

Not taking enough medicine; Taking too much medicine; Not observing the correct interval between doses;

Compliance Following Medical Advice 3 Compliance: An Introduction

Not making the correct duration of treatment; and Taking additional non-prescribed medicationsTwo meta-analyses of treatment studies (DiMatteo, Giordani, Lepper & Croghan, 2002) indicated large differences in the medical outcomes of adherent versus non-adherent patients. These analyses showed that adherence can make a big difference in improvement (Brannon & Feist, 2010). Biological, psychological and sociocultural factors contribute to failures in adherence. For example, after seeing a physician about an illness or injury, many people never get their prescription filled (Snooks, 2009).

One of the biological determinants is fear that the medicine will cause stomachaches. A psychological reason might be resistance to the idea that they actually need to take a medicine; and Sociocultural reason may include economic concerns about the cost of medicine or the time it will take to get the prescription filled.

Assessing AdherenceMeasuring adherence is a complicated process in medicine and health psychology. All techniques for measuring adherence have advantages and disadvantages. Medical practitioners tend to over-estimate patient adherence to their recommendations. Many physicians simply assume patients will follow their instructions. When they do not hear from the patient they

Compliance Following Medical Advice 4 Compliance: An Introduction

assume that their treatment recommendation was followed and was effective. There are many ways through which adherence can be assessed (Snooks, 2009). These are as follows:

Measurement of Medication:Measuring the amount of remaining medication is one way to monitor patient cooperation. Counting remaining pills and weighing liquid medications left in the bottles are used when studying the effectiveness of drug. In hospitals, people who distribute medicines stay at the bedside until the patient swallow the medication; however, there is less control in home situations. Other techniques are pharmacy database review, computer-based monitoring, and home nursing visits to ensure medication is taken and bandages are changed.

Biological and Chemical Monitoring:Measurement of adherence may include assessing the effects of the recommendation process or medication to be sure that the suggestions were followed. Some examples are weighing weight loss or gain, taking blood pressure and heart rate, and analyses of blood and body wastes. Some smoking cessation programs monitor adherence by analyzing exhaled breath. Repeated assessment is difficult if patients refuse to keep monitoring appointment.

Patient Self-Report:It may seem straightforward to ask patients or participants if they followed recommendations, but many times self-report are inaccurate. For example, many weight loss programs require patients to write down everything they eat each week. People are embarrassed when they eat the entire package of cookies, so they simply

Compliance Following Medical Advice 5 Compliance: An Introduction

omit writing about it. The same behavior occurs with regard to reporting exercise adherence, because people want to please their trainers or coaches. In the case of asthma attacks and chest pain, patients are more likely to use medications, but may not remember how many times the attack or pain occurred.

Electronic Monitoring Devices:One of the newest ways of measuring adherence is computer based monitoring and telehealth. Web-based interventions are assessable, low in cost, standardized, personalized, private, continent and may produce more accurate reporting of behaviors. Treatment outcomes might be a way to assess nonadherence, but there is little evidence of a clear relationship between the extent of adherence and health outcomes. In short, many factors obscure the relationship between adherence and recovery (Taylor, 2006).

Rates of Adherence in Medical TreatmentIt is important for heath specialists to know the rates of patient adherence in order to evaluate the effectiveness of counseling sessions, health-promotion programs, medical advice or prescribed medications (Snooks, 2009). Adherence is difficult to measure but clinical studies give some indication.

Estimates of non-adherence vary from a low of 15% to a staggering high of 93%. On average, non-adherence is about 26% (DiMatteo, Giordani, Lepper & Croghan, 2002).

Between 50% and 65% of out-patients do not adhere to their medication regimens (Schuab, Steiner & Vetter, 1993)

Compliance Following Medical Advice 6 Compliance: An Introduction

Many smokers relapse in the first 3 months after quitting. In alcohol addictions, relapse often occurs during the first two years (Snooks, 2009) For short-term antibiotics regimens, it is estimated that at least one-third of all patients fail to comply adequately (Rapoff & Christophersen, 1982) Between 50 to 60% of patients do not keep appointments for modifying preventive health behaviors (DiMatteo & DiNicola, 1982). As many as 80% of the patients drop out of lifestyle change program designed to treat smoking or obesity (Dunbar & Agras, 1980). More than 80% of the patients who receive behavioral change recommendations from their doctors such as stopping smoking or following a restrictive diet fail to follow these recommendations (Taylor, 2006).

In a study of children treated for the ear infection, it was estimated that only 5% of the parents fully adhered to the medication regimen (Matter, Markello, & Yaffe, 1975).

Heart patients, who should be motivated to adhere, such as patients in cardiac rehabilitation, show an adherence rate of only 66 to 75% (Center for the Advancement of Health, 2003).

Of 750 million new prescriptions written each year, approximately 520 million are responded to with partial or total non-adherence (Buckalew & Sallis, 1986).

Adherence is typically so poor that researchers believe that the benefits of many medications cannot be realized at the current level of adherence that the patients achieve

Compliance Following Medical Adv