The Role of Compliance with the Rules of Diabetes Patients in Follow-Up - Essay Example

?Does The Follow Up With One Single Physician In Diabetic Clinic Improve Compliance? College Compliance also known asadherence in relation to medicine is the extent to which a patient behavior relates to a medical advice. Medical compliance is very critical to any healthcare experts. It is important in the treatment and disease prevention. Compliance depends mainly on the patient as well as the physician commitment to the patient. However it saddens to know that many physicians have issues with compliance and this also include patients. The compliance of diabetic patients is estimated to range from 11% to 93%. It is also estimated that around a third of the total diabetics patients fail to complete their medications. Poor compliance places the patients a t risk of continued disease and also complicates the relationship between the patient and the physician. This article looks at how compliance can depend on the way that a patient relates with the physician. It also looks at the relationship between a patient who only sees one physician and that patient with many physicians and compares their level of compliance based on these facts. It is noted that a one on one relationship is needed for patients to increase their level of compliance. This is because this will enhance better communication between the physician and the patient. Our main question is, can the level of compliance be increased if a patient only has one physician and can the level of compliance be reduced in the event where a patient has many physicians. The article tries to look at 20 articles that deal with health records and try to read and understand the relationship between having one physician and compliance. 20 articles have been looked and out of them 4 have been selected and given a critical appraisal. Introduction Diabetes is a disease that is affecting most people in the world today. Once someone has been diagnosed with diabetes it is always normal for them to come after some to the hospital or health care centers for medication and advice on how to live healthy and what to do and what not to do. When these patients come to the health facilities some hospitals will keep changing their physicians while some will just maintain one physician for every patient, meaning that a patient will only be able to see the physician that he saw on the first date and not keep changing the physician. In this research paper, 20 articles are taken and used to compare the relationship between seeing one physician and seeing different physicians. The search strategy used in this paper is known as Framing the research question, in this type of search analysis, the question is framed and then put on the search engine for and used to search for the 20 articles. The search terminology used includes “compliance”, and “a patient with one physician”. I came up with questions such as “what is the relationship between having one diabetes patient and compliance in medicine”. Out of this I found thousands of articles and selected 20 articles which I have used for the paper. Later on I selected 4 of the articles and did a thorough analysis of them and came up with the information that will be discussed below. The four articles were selected mainly based on their content and the data that they contain. 20 articles were selected from the internet and used for analysis. There were two searches that were used, the first search was limited to the records of the past 2 years about the patient dropout while the second search was limited to the records of patients who dropped out of their medications or refused medication. The 20 articles that were used for this paper were valid to clinical relevance. It is however important to note that the reliability of the data is not guaranteed since some of the patients don’t report cases of incompliance. This is to say that compliance is lower than reported. According to Elliot (2000, p.120), a research using diabetes patients in England showed that there was 60% compliance. However further study revealed that there was only around 12% compliance meaning that the other 48% had lied about the compliance. It is for this that they looked for a standardized method for measuring medical compliance. Body Change of the organization or the physician who attends to a particular patient has a lot of effect on the patient relationship with compliance. It is reported that around 25% of the total cases of incompliance is due to change of the physician who takes care of the patient. Patients who were with one physician were found to comply more than those who had their physicians changed. Why is this so? According to James (2008, p.1120), the issue of change of diabetics physician on the patients mainly result from lack of physician s to take care of all of the cases of diabetes. It is said that out there is a ratio of 1:600 of physicians to patients meaning that for every 600 patients there is only one physician. It should also be clear that not all these physicians are qualified to treat diabetes patients; some are just practicing who must be given orders from their bosses in order to do what is needed. So you get to find that the qualified physicians are on demand and this sometimes forces them to leave their duties for their juniors so that they can perform them in the in absence. Some physicians are also known to be very lazy and they leave their work for others when they are not around. This has greatly affected the diabetes patients so bad that they sometimes have to go to untrained professionals or just have to go to pharmacist for their medications without consulting their physicians Jack (2008, p.330). Patients are also partly to be blamed. Some patient’s change their locations and this make them has to change their physicians. Other patients also refuse to be treated by some physicians because of their personal issues and so the y end up with different physicians after their first visit. This will therefore lead to them changing their physicians because of their own personal issues. The effects of changing a physician are so many and this is partly why it affects the compliance by the patients. The reason why a change in physician leads to a drop in compliance can be attributed to the personality and opinions of both the patient and the physicians. Everybody has their own personality and when two people meet the way that they will interact is very much different from the way that they would interact with other people. So when a patient meets a physician on the first visit, their interaction may be so different from how he would interact with another physician who has the same qualifications. This would definitely bring change on the way that this patient will relate to his medication. If on the first visit the patient meets a person with good personality and they click then there is high probability that the two would work together and that their way of interaction would be good. However if this person comes the second day and meets a total stranger who has different personality from the person that he first met then what will happen is that he might lose the psyche that he first had with his medication and instead start having some attitude toward s the new person. Physicians are also known to have different opinions and way of treatment. If a patient visits a physician and then the next visit he is directed to someone else other than the previous doctor then he may be confused coz they might give different prescription which might contradict the ones that he had been given before. This can be bad especially on diabetes patients who are very fragile medically Samson (2009, p.450). The other reason why a change of a physician can be bad on a diabetes patient’s compliance is that most of the physicians have different methods of treatment. There are a million ways to treat a disease and there is no guarantee that two physicians would use the same method to cure the same disease. So when a patient has a change of a physician then they may use different methods to try and treat him. These two methods might contradict and lead to low compliance. Methods and methodologies The 20 articles were obtained through the internet. The first search was limited to the first 2 previous years and was related to the medication and compliance based on the patient’s dropouts as well as treatment refusal. Out of this 250 articles were found and their relevance in terms of medicine was weighed. After that a second round search was done and this time it was limited to some specific terms. The keywords physician and diabetes were this time round used and 35 articles were found. 20 articles were then selected from the 35 based on the relevance of their topics of discussions. Out of the 4 articles the first one was from a survey in New Zealand. The researchers had to ask for permission to interview the patients and those who were responsible for them in their practice rooms. Those patients and caretakers who were coming in were interviewed about how they complied medically with their medicine. Their contacts were taken and after around 2 days they were telephoned to know how they were fairing. Compliance with the medical therapy was the main thing that they were asked to speak of. The study was approved by the government and some organizations to be able to work. The survey instruments that were used have been used for international study of trust and continuity. In the instrument the compliance tools and the patient physician relationship looked into. Part 1 of the survey was completed within a short time and the consultation included the following. Health and demographic information In order to answer the New Zealand census question patients were used for ethnicity. The education of the patients was based on high school degree, while their health status based on diabetic patients. The economic background of the patients was also looked into and then given out. The level of the health status was also checked and used to look into the issue. A very important factor was then checked the interaction between the physician and these patients and how this affected their level of compliance. EuroQol 5-dimensional questionnaire was used to question the patients. Source of care This was asked to know if there was any particular physician who the patients trusted in and with whom they would go to whenever they had any questions that needed some answer and how this related to their level of compliance. And what did they do in case they didn’t find the physician that they always go to? These are some of the questions that were asked in order to know if indeed there was a relationship between physicians and the compliance level. Continuity of care was measured in 3 measures. The length of continuity was measured using the measures by measuring how long the patient has been seeing the physician and what is their relationship with the doctor. It is important here to note that not only diabetes patients were questioned but even other patients. This was so that it would provide some base for comparison. The importance of continuity was asked by trying to find the importance and reason why most of the patients preferred to see only one physician. The usual provider continuity index was then calculated from this and it was found that this one was one of the most widely used methods of measuring continuity. Trust in the physician The trust in the physician was measured using the trust in the physician scale. The score yielded ranged from 11 to 55 with a higher score representing trust in the physician. The trust was measured before consultations so as to assess established trust in the physician. After the consultation the trust was also measured to find how they were related. Physician-patient concordance The following questions were put forward to assess the agreement between the physician and the patient. “to what extent do you think the doctor understand why you have come to the hospital” “do you think the physician understood you today” “What extent did you and the doctor agrees on what you should be doing after your visit and before the next visit. “do you and the doctor agree on what part you should play in the medication” “do you and the doctor agree on who should be responsible for different aspects of healthcare” Patient Enablement The enablement index was used to know if indeed the physician enabled the patient towards effective healthcare. The main point of reference was the patient’s availability to cope with the life issues. Consultation with the physician was also a very important aspect in the patient enablement process. The responses had a score ranging from 1 to 4 Liptak (2010, p.230). Measures medication compliance To know their compliance the patients were first asked if they were given any prescription on their first visit to the clinic. After 4 days each patient was called to know if they had followed the prescription well, if they were taking the medication as they had been instructed, and if they were not the reason was asked and noted down. A patient was classified as compliant if they were given their prescription and if they were following this prescription after the 4 days. A patient was considered not to comply if he received thee prescription and was not taking it after 4 days. Those who never had a prescription were not included in the research Samson (2011, p.340). Analysis Statistics were produced in numeric representation to show how the sample and the summery responses correlated. The patient physician correlation was computed first for the non diabetic and then for the diabetic. Logistic regression analysis was performed to examine the relationship between the physician change and compliance. Health status, age, ethnicity were all used as variables of control. If follow up with correspondent had not been successful then the values were consider to be missing. These cases were omitted from the list and only those with follow up were included. Results 22 physicians out of the 27 that were approached were enrolled in the study. Out of the 490 patients that were involved only 370 took part in the study. On average 16 patients were enrolled with each physician. Some patients were excluded out of the study because of their age or because they could not be found for the telephone conversation. The table below shows how the compliance was related to the patient-physician relationship. Type of patient in relation to physician. Number of the patients Number of those who complied Percentage of those who complied Patient with one physician 200 190 95% Patient with more than one physician 170 100 58% This table clearly shows that there is a big relationship between compliance and the physician patient’s relationship. It is important to note that some patients may give wrong information just to please the person interviewing them and so this is just but an assumption that is made after the study. Principal findings Patients who had just one physician were one third likely to comply to comply to medication as opposed to patients who had more than one physician. In contrast however the continuity of the medication highly depended on the trust the patient had with the physician. These were not related to compliance and medication. Study strengths and weaknesses This study was a preplanned evaluation of the relationship between compliance and the number of physician that a diabetic patient was able to see. Measures were used to detect the level of compliance. Primary care and patient response and trust is a factor that is well considered here. The analytical report took into account the sampling frames and the people to be sampled. The results should however be treated with caution since the medication results were given by the patients themselves and no one was there to confirm if they were saying the truth. This is the main weakness of this report and should not be neglected since it is very important. Pills and pharmacy audits were not within the scope of this study. The relationship between the patient and physician relationship test has not been validated and s o all this should be put into account and not neglected. Despite all these limitations it is very important to note that the relationship between the physician and the patient exist here and should not be neglected. The study was also limited to responses from the minority who were given prescription while those who were never given the prescriptions were left out of the study. This also gives wrong results since some of the patients who never got the prescription had something to do with their medication compliance and so they should also have been put on the test or the reason behind their non prescription researched upon to see if they related to any of the above issues. Article 2 This article was based purely on diabetic patients and compliance and the relationship between their compliance and the no of physicians that they were able to see on their visits. This report was mainly based on that analysis of current articles that had been produced by US universities. Identification of non compliance Non compliance was found to be a major problem where the patient had many physicians and this was connected to the relationship between the patients and the physician relationships with respect to their way of compliance. Much of the research that deals with patient compliance deals with the patients sticking to the medication that he has. It is approximated that 125000 people in the US die of treatable diabetes each year and the reason behind this is that most of them do not take their medication seriously or they simply can’t adhere to their prescription. In this research 14 to 21 percent of the diabetes patients don’t fill their prescription. Out of this it is noted that 60% of the total number that don’t fill their medication actually don’t see one physician and keeps changing physicians every time. Some patients are also noted to identify their own medication and this comprised of a large number of the patients that existed in the group that was interviewed. The administration was also partly to blame since they are the once who kept changing the physicians. It is reported that 12% of the total patients that did not comply with their medications complained to the administration about the change in the physicians who were taking care of them. Some patients were also found to take the medication of others, these patients are said to have no trust in their physicians. It is also important to note that it is very expensive to treat the patients who don’t comply to their medications due to the huge sums of money that they should be used for their medication. The role of the patient to compliance from this report Much of the literature that is available mainly focuses on the role of the patient with relation to compliance. It is argued that the patient is the one who should be taking the medication and so he should be the first person to be blamed in the event where non compliance arises. Some patients are just too stubborn and won’t take their medication and so the best thing to do is to make follow up with them. A single physician who understands the patient would be good for him and so it is not advised that such a patient keep changing physicians as this could be bad on his health. The role of the physician on compliance Physicians should let it be their job that the patients comply with their medications. If a patient does not comply to his medication then it should be the concern of the physician to know what exactly happened to the patient to the extent that he did not comply to the medication that he was given. The physician should also report cases of non compliance to the hospital administration so that a statistics can be made and a problem be looked to find why the patients are not taking their medications. This also applies to the cases of those who comply with their medications Elliot (2008, p.300). Article 3 In this article the main thing that was discussed here was the relationship between the physician and the patients and how this affected the level at which the patients complied to their medications. The research was conducted in the US and 400 patients were used to compile the report Shift in the physician-patient relationship Changes in the organization, really affects the way that a patient complies with his medication. This has highly affected the practice environment. Pressure from the administrators highly affected the continuity of the patient to his medication Donoval (2009, p.798). It is shown that there is a big relationship between the physician that a patient sees and the changes that he makes to his patients. The shift is seen to have some psychological shift in the way that a patient relates to his medication and the way that he is affected by the shift. The graph below shows how the patient compliance was related to the shift of the physician in the past 3 years in the US. This graph is a clear indication that there is a relationship between the level of compliance and the number of physicians that a patient sees. It is shown that a patient who sees one physician is one third likely to comply with the medication as opposed to the one who sees many physicians. Article four This article was based on adherence of diabetes patients to their medications and had to show if there was any relationship between the patients and the way that he related to his physician. The study was conducted in Canada and a total of 300 patients were used Thompson (2008, p. 487). How do we know that it is time to intervene? This is the main question that this article tried to address, when every patient that visits a particular physician, or if any patient who passes through a physician has to have issues that are related to compliance then we should know that it is time to intervene and come up with a solution to the problem that has been created. This is always as a result of many patients not following the instruction of that particular physician maybe because of his personality or because of the way that he prescribes his medication. So the physician should be talked to improve on his personality or measures taken against him. Lower cases off adherence are usually reported in places where patients are allowed to go home and take their medication at home. In the event where a patient is noted not to take any medication when away from the hospital then the best thing to do is to administer the medication in front of the physician or the patient is admitted into the hospital so that he can be cared for Newell (2009, p.450). Application of findings to the organization As a health recorder the above learned information can be of much help to the hospital health management. The first thing that should be done is that every patient that comes to the hospital should be allocated his own physician to take care of him. No patient who comes for the second time for medication should be directed to a physician that he had not seen before otherwise there might be a problem. Patient information and the way they comply with their medication should also be checked to know what is going on. This is important as there is no assuming that all those who leave the hospital will actually take their medication as they had been told. Those who do not take their medication should be recorded and possible reasons why they do not comply with their medication looked into. The hospital database should also be programmed such that when a patient books an appointment then he can only do so if and only if the physician that he had seen before is available for the appointment unless it is a case of emergency. The physicians should also have to stick to their appointments unless they have something very useful that they would like to do in which they would have to give orders to the new physician on how to deal with the case that they leave behind Bergman (2007, p.676). It is also important to keep the records of all the patients who have been treated and have booked an appointment for the next visit. This is very important for them because the next time they visit they will be directed to the physicians that they had met in the first appointment. Conclusion Although the issues that are addressed here might appear to be simple there is need for them to be addressed. The issue of non medical compliance is really costing lives and money. Many diabetic patients die at conditions that can be treated and which they could have prevented if only they could have stuck to their medication and not neglected their medications. The goal of such recommendations that should be put into effect is not to be so strict on the patients but to try and train them so that they are able to understand themselves and the need to comply with their medications. It should also be put clear to the patient that compliance is very vital to the healing process and those who don’t comply with their medication would have serious consequences upon them and so they need to comply with their medication in order to get well quickly and stop the process of not being able to get better from their condition Donoval (2008, p.700). Diabetic patient should also be told of the importance of seeing just one physician and their attitude towards these physicians should be changed otherwise they might end up taking the wrong prescription. It is however important that every diabetic patient only stick to one physician and all hospital administrators should put this into effect. Those who book appointments for the patient should also remember to book the appointment with the physician that the patient had seen before and not any other physician. Bibliography Jack, C,2009, “Adherence To Medication In Diabetic Patient And Factors Behind Them”,1,3, Accessed on 31 October 2011, Available through Medical articles database. Samson, F, 2008, “Compliance With Pediatric Therapy”, 3,2, Accessed on 31 October 2011, Available through Medical articles database. Elliot, V, 2008,”Parental Health Beliefs And Compliance”, 1,2, Accessed on 31 October 2011 Available through Medical articles database. Daniel,G, 2010, “Compliance Inmedication And Possible Solutions”, Accessed on 31 October 2011, Available through Medical articles database. Newell, S, Bowman, J, 2009, “Critical Review Of Inter Entions To Incrase Compliance In Medicine”, Accessed on 31 October 2011, Available through Medical articles database. Donoval, J, 2010, “The Missing Ingredient In Compliance”, Accessed on 31 October 2011, Available through Medical articles database. Cramer, J. 2010, “Relationship Between Medication Compliance And Medication Outcome”. Accessed on 31 October 2011, Available through Medical articles database. Thompson, S. Dahlquist, L. 2008, “Staff And Compliance In Medication Among Patients”, Accessed on 31 October 2011, Available through Medical articles database. Davis, M, 2009, “Family Behaviour And Adherence In Medication Among Diabetic Patients”, Accessed on 31 October 2011, Available through Medical articles database. Bell, F, 2010, “How To Improve Medical Compliance”, Accessed on 31 October 2011 Available through Medical articles database. Liptak, G, 2010, “Patient Compliance In Diabetes Patients”. Accessed on 31 October 2011, Available through Medical articles database. Berstein, A. 2010, “ Compliance In Medicine”,Accessed on 31 October 2011, Available through Medical articles database. Fadiman, A. “Physician Patient Relationship And Compliance”. Accessed on 31 October 2011, Available through Medical articles database. Galanti, G. 2010, “Caring For Diabetic Patients”, Accessed on 31 October 2011, Available through Medical articles database. Bartlest, S. “How To Take Diabetes Medication”, Accessed on 31 October 2011 Available through Medical articles database. Clark, N. 2011. “Impact On Education On Patient And Physician Relationship And Compliance To Medication”, Accessed on 31 October 2011, Available through: Medical articles database. Mascot, D. “How To Increase The Level Of Compliance”. Accessed on 31 October 2011, Available through Medical articles database. Dresser, G, “The Effects Of Non Compliance In Medication”, Accessed on 31 October 2011, Available through Medical articles database. Samson, P, “Introduction To Medical Compliance”, Accessed on 31 October 2011, Available through Medical articles database. Bergman, A, “Non Compliance And Their Effects On Medicine Today”, Accessed on 31 October 2011, Available through Medical articles database. Literature Review Grid Source Methodology Population/ Sampling Data Collection Data Collection Tool Data Analysis Validity/ Reliability Ethics Theme 1 Theme 2 Theme 3 Theme 4 Article “Non Compliance And Their Effects On Medicine Today. Article Introduction To Medical Complianc Secondary sources of information. That involving searching for the relevant articles. 20 articles selected and reviewed out of the 20 four are taken for further study 20 articles were selected from the internet and the data from them used in the study. The internet Regression analysis for comparison Reliable but with some few areas that should be looked into Medical ethics Compliance in medicine Relationship between patient and the physician Diabetes patients and compliance. Article The Effects Of Non Compliance In Medication Article How To Increase The Level Of Compliance Secondary research Qualitative methodology. 20 articles selected and reviewed out of the 20 four are taken for further study 20 articles were selected from the internet and the data from them used in the study The internet Use of tables and graphs Article On Patient And Phusician Relationship And Compliance To Medication Secondary research Qualitative methodology 20 articles selected and reviewed out of the 20 four are taken for further study 20 articles were selected from the internet and the data from them used in the study The internet Regression analysis for comparison Article How To Take Diabetes Medication Secondary research Qualitative methodology 20 articles selected and reviewed out of the 20 four are taken for further study 20 articles were selected from the internet and the data from them used in the study The internet Regression analysis for comparison Article Caring For Diabetic Patients Article “Physician Patient Relationship And Compliance Secondary research Qualitative methodology 20 articles selected and reviewed out of the 20 four are taken for further study 20 articles were selected from the internet and the data from them used in the study The internet Regression analysis for comparison Article Compliance In Medicine Article Patient Compliance In Diabetes Patients Secondary research Qualitative methodology 20 articles selected and reviewed out of the 20 four are taken for further study 20 articles were selected from the internet and the data from them used in the study The internet Regression analysis for comparison Article How To Improve Medical Compliance Secondary research Qualitative methodology 20 articles selected and reviewed out of the 20 four are taken for further study 20 articles were selected from the internet and the data from them used in the study The internet Regression analysis for comparison Article Behaviour And Adherence In Medication Among Diabetic Patients”. Secondary research Qualitative methodology 20 articles selected and reviewed out of the 20 four are taken for further study 20 articles were selected from the internet and the data from them used in the study The internet Regression analysis for comparison Article Staff And Compliance In Medication Among Patients Secondary research Qualitative methodology 20 articles selected and reviewed out of the 20 four are taken for further study 20 articles were selected from the internet and the data from them used in the study The internet Regression analysis for comparison Article Relationship Between Medication Compliance And Medication Outcome Secondary research Qualitative methodology 20 articles selected and reviewed out of the 20 four are taken for further study 20 articles were selected from the internet and the data from them used in the study The internet Regression analysis for comparison Article The Missing Ingredient In Compliance Secondary research Qualitative methodology 20 articles selected and reviewed out of the 20 four are taken for further study 20 articles were selected from the internet and the data from them used in the study The internet Regression analysis for comparison Article Critical Review Of Inter Entions To Incrase Compliance In Medicine 20 articles selected and reviewed out of the 20 four are taken for further study 20 articles were selected from the internet and the data from them used in the study The internet Regression analysis for comparison Article Compliance Inmedication And Possible Solutions Secondary research Qualitative methodology 20 articles selected and reviewed out of the 20 four are taken for further study 20 articles were selected from the internet and the data from them used in the study The internet Regression analysis for comparison Article .”Parental Health Beliefs And Compliance Secondary research Qualitative methodology 20 articles selected and reviewed out of the 20 four are taken for further study 20 articles were selected from the internet and the data from them used in the study The internet Regression analysis for comparison Article Compliance With Pediatric Therapy Secondary research Qualitative methodology 20 articles selected and reviewed out of the 20 four are taken for further study 20 articles were selected from the internet and the data from them used in the study The internet Regression analysis for comparison Article Adherence To Medication In Diabetic Patient And Factors Behind Them Secondary research Qualitative methodology 20 articles selected and reviewed out of the 20 four are taken for further study 20 articles were selected from the internet and the data from them used in the study The internet Regression analysis for comparison Read More

 

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