Victoria Oladimeji (Ph.D., MA, MBA, BA, RGN, RM)

1. PROMOTING MEDICATION COMPLIANCE FOR PATIENTS WITH DIABETES • Victoria Oladimeji (Ph.D., MA, MBA, BA, RGN, RM) • Lecturer in Nursing With Specialty in Health Promotion • City University St. Bartholomew • School of Nursing and Midwifery, • Philpot st White Chapel • London EC1 2EA • Tel: 020 7040 5887

2. Abstract • The effectiveness of treatment of a disease depends mainly on two factors: the efficacy of the treatment prescribed and the rate of compliance of the patient with this treatment. • Non-compliance could lead to lack of response to treatment or worsening of the existing medical and nursing problems. It could also lead to unnecessary lengthening of patient’s stay in hospital. In the current atmosphere of cost-cutting and waste minimization, hospital and ward managers are looking for ways of improving the quality of care provision for patient in order to ensure successful rehabilitation at home. Improving medication compliance by patients is one way of improving the quality of treatment regimes in hospital as well as ensuring effective rehabilitation and prevention of re-admission of patients to hospitals. • The aim of this poster is to explore ways of increasing medication compliance for older adults in hospital settings.

3. Introduction • Non-compliance with medication can be considered one of the most serious problems facing health care (Urquhart, 1992; Wright 1993). • This paper explores ways of improving medication compliance amongst older adults in hospital settings. Strategy for improving medication compliance is offered.

4. The effectiveness of treatment of any disease including diabetes depends mainly on two factors: • 1. the efficacy of the treatment prescribed. • 2. the rate of compliance of the patient with this treatment (Vallis et al 2003). • Non-compliance, in diabetes, occur more frequently when patients: • are older (Weingarten and, Cannon 1991). • receive more medication (Stuart and Coulson 1993) and or experience side effects • have to take their medicines regularly, and over a long period of time( Nicholas et al 1995)

5. Literature Review • Various studies have shown a relationship between the number of doses to be taken and compliance, but others provide no evidence for such a relationship. The results of these studies are not fully consistent, but they provide in general a view of a higher compliance with once- or twice-daily doses than with three- or once-daily doses (Nicholas et al 1995). • Vallis et. al (2003) found that willingness to change in relation to medication compliance are correlated with sex, age, marital status, BMI, diabetes education, quality of life, and social support. • Lack of knowledge or understanding either of the illness or of the medications prescribed to treat it can lead to non-compliance of medication regime.

6. Non -compliance depends on: • Complexity of the treatment. • Length of time during which the patient has to follow advice. • Whether the treatment is seen as potentially life saving. • Severity of the illness as viewed by the patient. • Patients’ feeling of improved health status (Cargill 1992; Vallis 2003) Cargill (1992) found that patients took insufficient medication because they felt they had been over-prescribed. He also identified patient-nurse relationship that was built on trust as influencing factor. Becker’s Health Belief Model focusing on the need to motivate and educate the patient in order to enable them to make informed decisions should be considered.

7. According to Becker (1974) the rationale behind the Health Belief Model is that the individual’s decision to take action will be based on certain criteria such as: • Susceptibility- the individuals’ belief that the disease will occur or re-occur. • Severity of the risk or illness. • The benefits to be gained from complying with therapy. • Cues to action - i.e. stimuli which trigger appropriate health behaviour.

8. Diverse factors- Demographic, cultural, social and personality factors that may influence health behaviour. • These link into the patient’s social and family circumstances.Other factors include: Inadequate explanations of medications. • Possible side effects. • Presentation - child proof containers and blister packs are difficult • Manipulate particularly for the older person. • Small print difficult to read. • Altered general mental functioning in some older people MacDonald (Vallis, 2003).

9. Knowledge and understanding of illness • Knowledge of the illness and the desired effect of therapy facilitates compliance (Vallis 2003) • Vallis suggested that it is not just knowledge that is important but understanding and application of the knowledge.

10. Level of communication.Level of motivation & commitment. • If patient has failed to comply with regime in the past, find out why and consider other options. • Availability of resources e.g time /personnel/ environment. • According to Mager (1962) learning involves 3 domains: • Cognitive (information and understanding) • Affective (attitudes and feelings) • Psychomotor (skills) • Patient education needs to incorporate all three aspects.

11. Factors to be consider in planning and implementing education for medication compliance: • Number, content, timing, and pace of sessions, • Resources • Feedback • Involvement of the pharmacist • Written information • Flexibility • Post-discharge teaching

12. Conclusion • Medication compliance for patients with diabetes is one way of improving glycaemic control and minimizing some of the complications of diabetes. • Application of Becker’s Health Belief Model enables the health professional to assess the needs, motivate and educate the patient in order to enable them to make informed decisions.

13. References • 1. Becker M. H. (1974) - The Health belief model and sick role behaviour, Health education monographs. winter. • 2. Cargill J. M. (1992) - Medication compliance in elderly people. Influencing variables and interventions. Journal of advanced of Nursing. 17. 422-426. • 3. Mager R. (1962) Preparing instructional objectives, California: Fearon. • 4. Nicholas WC, Fisher RG, Stevenson RA, Bass JD: Single daily dose of methimazole compared to every 8 h propylthiouracil in the treatment of hyperthyroidism. South Med J 88:973-976, 1995 • 5. Stuart B, Coulson NE: Dynamic aspects of prescription drug use in an elderly population. Health Res 28:237-264, 1993 • 6. Urquhart J: Ascertaining how much compliance is enough with outpatient antibiotic regimens. Postgrad Med J 68 (Suppl. 3): S49-S59, 1992 • 7. Vallis M, Ruggiero L, Green G, Jones H, Zinman B, Rossi S, Edwards L, Rossi JS, Prochaska JO: Stages of change for healthy eating in diabetes: relation to demographic, eating-related, health care utilization, and psychosocial factors. Diabetes Care 26:1468-1474, 2003 • 8. Wright EC: Non-compliance: or how many aunts has Matilda? Lancet 342:909-913, 1993 • 9. Weingarten MA, Cannon BS: Age as a major factor affecting adherence to medication for hypertension in a general practice population. Fam Practice 5:294-296, 1988