Hypertension therapy and patient compliance

In the treatment of chronic disease like hypertension it is very important to achieve good patient compliance. One third of the patients however takes his medicament irregularly. The failure of the treatment is usually caused by the patient, who is not aware of his illness, he feels healthy that's why he does not go to see the doctor or he stops taking the medicine. The cause of bad compliance can also be the doctor who does not spend enough time and energy on his patients. Rarely the therapy is broken off because of the side effects of the medication. In the last year 100 patients with hypertension were asked with help of a questionnaire about their drug-taking habits and their knowledge about hypertension. From the answers we found out that one third of the patients takes his drugs irregularly. Less than half of the patients reaches the normotension. Most of the patients who have been treated for many years do not know the goal blood pressure, the possible complications of hypertension, the goal of the treatment. Often they do not even know the name of their medicine. Compliance is a complicated problem. Improvement could be reached by regular teaching of the patients, by teaching the patients how to measure blood pressure at home, by increasing the number of educational publications, by regular training of the doctors, by keeping the rules of the treatment, by using modern and long-term effective drugs. It would be important to start with teaching the healthy way of living already at a young age.     

Increasing patient compliance through the applied analysis of behavior.

Applied Analysis of Behavior (ABA) provides a systematic and easily acquired technique for increasing adherence to medication. This is a problem-solving process which can be readily employed on behavioral problems in drug adherence. A number of observation, cueing and reward techniques are suggested to increase adherence. Various dimensions of adherence behavior can be systematically observed and modified to increase compliance. ABA, due to its simplicity, has been successfully employed by nurses, patients, physicians and parents on many health or health maintenance problems. The main point of this paper is that both the patient and physician can profit from often employed clinical scientific techniques: naturalistic observation of behaviors and events functionally related to the event under analysis—in this case the act of taking medication.     

Increasing the odds of patient compliance through prescription warning labels.

Ensuring patient compliance with instructions for medication continues to be a major problem. The authors report an experiment suggesting that warning labels promote compliance. In addition, other methods of improving compliance are discussed.     

Relationship of physician behavior to patient compliance

The authors investigated patients' perception of two aspects of physician behavior during patient-physician interaction, namely, explanation given to the patient and concern for the patient. The relationship between these factors and patient compliance with the therapeutic regimen was then determined. Results showed a statistically significant relationship between these two aspects of physician behavior and patient compliance: the more patients perceived the physician as giving explanations and showing concern, the better was patient compliance.     

Contributions of public health to patient compliance

This paper discusses the contributions of public health to compliance in five areas: clinical trials, smoking cessation, dietary compliance, breast cancer screening and hypertension control. Public health programs have been based on a number of theoretical foundations, most notably, social learning theory and the health belief model. Social marketing, community organization, and, more recently, consumer information processing models also are important. The strongest public health programs embody an ecological approach, with interventions directed not only at individuals, but also at groups, communities and changing institutional norms. Among the most important contributions of public health interventions are: multiple levels of intervention and evaluation, tailoring to target audiences, use of social support and community organization for behavior change. Together, community health and clinical compliance-enhancing strategies can exert a synergistic impact on health behavior change.Barbara K. Rimer is Director, Cancer Control Research, Duke Comprehensive Cancer Center, Box 2949, Duke Univ. Medical Center, Durham, NC 27710; Karen Glanz, Ph.D. is Professor at Temple University, Philadelphia, PA 19122; Caryn Lerman, Ph.D. is Associate Member, Fox Chase Cancer Center, 510 Township Line Road, Cheltenham, PA 19012.Grant support was provided by National Cancer Institute Public Health Service Grant CA34658 and institutional grants awarded to Fox Chase Cancer Center NIH (CA06927 and RR05895) and an appropriation from the Commonwealth of Pennsylvania.Word processing was provided by Lisa Salerno and Kathy Smith.     

Experience with functional insulin therapy: metabolic follow up and patient cooperation

Functional insulin substitution, an insulin regimen made up of two daily injections of intermedier acting insulin and prandial boluses of regular insulin, was to be introduced in 49 type 1 diabetic patients, as previous regimens consisting of two or three daily injections proved to be inefficient due to the patients' lifestyle or inherent metabolic lability. 45 patients were treated with human insulin injected by NovoPen. In 38 cases therapy was changed in the frame of a one-week, small-group, inpatient, structured educational course. After a mean 14 months of follow-up metabolic status improved in 33 cases while there was further derangement in 16. 18 patients were practicing true functional therapy ie. doing blood glucose tests before each injection. Another 22 diabetics were trying to achieve better metabolic control through 2-3 daily blood glucose tests and insulin dose corrections. Metabolic status was not affected by the frequency of blood glucose testing, rather by the raising of the daily dose of Actrapid insulin in conjunction with the switch in therapy acting beneficially. All patients insisted on using NovoPen further on.     

How to improve patient education

There are a variety of ways to improve patient education. Healthcare managers should investigate the best practices used by the most successful providers and adapt the best ideas for use in their own organizations. Healthcare providers are increasingly recognizing that developing an effective system of patient education is one of the most cost-effective ways to maintain the health status of chronically ill patients. In an era of capitated payment and competition, the provider who can successfully partner with its patients to manage their health will be the one to survive.     

Interventions to improve hand hygiene compliance in patient care

Healthcare-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as the most effective method of prevention but is poorly performed by health workers. We report a systematic review identifying studies which investigated the effectiveness of interventions to increase hand hygiene compliance short and longer term and to determine their success in terms of hand hygiene compliance and subsequent effect on rates of healthcare-associated infection. We employed the inclusion criteria employed by the Cochrane Effective Practice and Organisation of Care Group. Forty-eight studies and one thesis were identified. Only two met the stringent inclusion criteria. Overall studies remain small scale, poorly controlled and follow-up data collection is abandoned too soon to establish impact longer term. Furthermore, designs are insufficiently robust to attribute any observed changes to the intervention. Studies lack theoretical focus and seldom describe the intervention in sufficient detail, the change management process or contextual information about the organisation in the depth necessary to explain success or lack of it. The review concludes that interrupted time-series studies may offer the most rigorous approach to assessing the impact of interventions to increase hand hygiene compliance. In such study designs the number of new cases of healthcare-associated infection should be taken as an outcome measure, with data collection points at least 12 months before intervention and afterwards to allow for seasonal trends. Contextual factors at national and at local level should be carefully documented to take into consideration the influence of secular trends.