Management of Adherence to the Treatment Regimen - Essay Example

Discuss psychological factors and theories regarding treatment adherence/compliance” Sub-optimal management of adherence to the treatment regimen becomes a blockade in controlling many infectious diseases including tuberculosis, AIDS, diabetes, hypertension, multiple sclerosis, asthma etc. Considering non-adherence to the treatment regimen to be a serious issue, the present article emphasize on the factors accountable for this non-compliance and the psychology that paves the way to discontinue the treatment when the condition improves. Introduction Psychology is basically concerned with behavior of the individual. Health psychology is an amalgamation of behavior of an individual along with biology and social issues. In its true sense health psychology encompasses clinical health psychology, public health psychology, community health psychology and critical health psychology (Marks, 2005). In the present scenario psychology finds its way in medical and physiological aspects, contributing to innovation in thoughts in terms of health and care facilities. The thought further gained strength from the acknowledgment of genetic predisposition along with behavior of the individuals encompassing ability to combat stress, beliefs of the individual about staying healthy, the positive attitude towards life and the kind of lifestyle an individual is leading. All these paradigms are essential in deciphering the nature of individual and the ability to combat disease of any critical condition. Along with these characteristics, social conditions like the attitude of family members, relationships in family, financial conditions, cultural and traditional values an individual possesses, the kind of co-operation an individual seeks from the social set up, the grooming of individual and the perception of the individual for life. All these are essential for the comprehensive understanding about the health psychology which is concerned with behavior of the individual and the kind of medication an individual is taking. In true sense health psychology encompasses protective study and intercession to endorse health and to trim down the jeopardy of disease. Two major issues that emerged in understanding health psychology are- the extent to which the healing is explicit (the placebo problem) and the echelon to which they are executed (the adherence to regimen) (Blackwell, 1976). It is evident that most of the reimbursement of medications could not be procured as they are not performed to their completion. It is essential that the patient adhere to the treatment regimen. Since 1973 research is being carried out to establish the factors serving as stumbling blocks in the path of adherence to treatment regimen. Theories have been formulated to overcome these hurdles and to rule out the side-effects which may serve as a major aversion from the treatment regimen. Consequently, adherence is a major issue witnessed by physicians and other health care professionals. The matter comprises an extensive range of behaviors by the patient, leading to crumpled adherence to treatment program, untimely annihilation of therapy and curtailed execution of directions together with prescriptions (Blackwell, 1976). Non-adherence is generally observed as redundant menace for an additional burden of morbidity and mortality in addition to the waste of health care resources. However, adherence is a recurrent observable fact with enormity from 12% of HIV disease and up to 33% in diabetes of non-adherence patients. When the conditions become chronic or complex, adherence becomes difficult for the patient (Klauer, 2008). Research reveals that patients of kidney failure have a preference of kidney transplantation. For the life of kidney they have to stick to the immunosuppressant medication. If they do not comply with this regimen then it results in rejection of transplant and again return on dialysis. This non-adherence results in enhanced mortality cases. The ratio accounts to 50% of the cases (Orr, 2007). Various factors that emerged as a result of research conducted to understand the factors predisposing the non-adherence of treatment regimen involve- Personal factors: it is observed that more than 50% of the patients discontinue taking prescribed medications for long-term therapy in first year of the treatment (Meichenbaum & Turk, 1987). It is also evident that this is equally true in asymptomatic conditions like hypertension, hyperlipidemia, osteoporosis, glaucoma, apart from other conditions like migraine, epilepsy, arthritis, depression and despair where adherence is highly imperative (O’Donohue, 2006). Logistic barriers to medication adherence encompassing drug and regimen factors: research is going on to come –up with ease in medication so that the patient sticks to the medication but not many results could be explained in terms of patients’ adherence to the regimen (O’Donohue, 2006). Financial Barriers to Medication Adherence: Prescription Drug Costs- this is also one of the important parameter for the non-adherence to the treatment regimen (O’Donohue, 2006). Education Barriers to Medication Adherence: Lack of Knowledge- lack of patient’s awareness including physicians themselves also show poor adherence to the treatment regimen. It is therefore imperative to educate the patient in true sense explaining al the consequences of non-compliance of the regimen (O’Donohue, 2006). Beliefs and perceptions about the illness, through communication: patient must develop trust on the physician; it is believed that this faith and belief affects the health outcomes. It is manifested that those who have trust on their physician possess stronger self-efficacy and show good expected outcomes. This also is a way for better adherence to the regimen. It is also established that physician should also take food concern to the patient and should respond to each and every queries that a patient has in order to maintain the trust. In this, appropriate and progressive communication is highly essential (Lee, 2009). Psychosocial factors: it is the psychology of the patient to get relieved from the treatment procedure to save the additional expenses and during the process the patient bring to a halt the entire medication as soon as first sign of recovery is witnessed. Family relationships: better family environment reduces the stress of the individual and hence creates a congenial environment around the patient. This helps the individual to be enthusiastic and feels strengthened to combat the ailments and stress. Although little has been achieved through Behavioral family systems therapy (BFST) in terms of adherence (Wysocki, 2005). Research outcomes- A thought to behavioral and related factors- to combat disease, cut smoking and improve upon healthy nutritional practice leads to health and minimize illness. Through health psychology reformations could be induced in reducing impulsive nature of the individual, anger, unbalanced emotions, despair (Dusseldorp, 1999). Health Psychology emphasize upon establishing a congenial physician- patient relationship, when there occurs a deficiency in understanding of the patient the physician should take a sympathetic and psychological step to overcome the issue rather getting irritated over the issue as this leaves a great impact on the psychology of the patient (Dowsett, 2000). Conclusion It is extensively understood that adherence to the treatment regimen is extremely crucial for long- term treatment accomplishment; still degree of adherence to the treatment regimen are repeatedly subtherapeutic. It is understood that attitude towards medication or therapy and psychosocial characteristics should be taken into consideration especially for long term diseases like tuberculosis, AIDS, diabetes, multiple sclerosis as these factors tend to create immature therapy and persuade untimely knowledge and skills with the adherence to treatment regimen. It is therefore imperative to propose treatment regimen keeping all these constraints into consideration. Fundamentally, measures of symptom suffering, wide-ranging health benefits and welfare, safety, security, personal and situational factors together with demographic distinctiveness, communal hold, self-efficiency, gloominess, strain, anxiety and existing adherence to medications should be taken into consideration. It is established that the significance of adherence and ability to take medications must be directed with constant monitoring and timely feedback to avoid any complications and to accomplish the treatment regimen. Discontinuation may lead to serious complications and also leads to drug resistance in due course. Constructive thinking must be inculcated in the psyche of patients to adhere to the therapy, this is further empowered through meditation and keeping a cool attitude towards circumstances. It is believed that individual and situational factors like depression, poor education are associated with poor patients’ compliance to the therapy. References Blackwell, B. (1976). Treatment Adherence. Brit. J. Psychiet. 129, 513-31. Dowsett, S. M., Saul, J. L., Butow, P. N., Dunn, S. M., Boyer, M. J., Findlow, R., & Dunsmore, J. (2000). Communication styles in the cancer consultation: Preferences for a patient-centred approach. Psycho-Oncology, 9, 147-156. Dusseldorp, E., van Elderen, T., Maes, S. (1999). A meta-analysis of psychoeducational programs for coronary heart disease patients. Health Psychology, 18, 506-519. Klauer, T. (2008). Compliance, adherence and the treatment of multiple sclerosis. Journal of Neurology, 255, 87- 92. Lee, Y., Lin, J. L. (2009). The effects of trust in physician on self-efficacy, adherence and diabetes outcomes Social Science & Medicine, 68(6), 1060-1068. Marks, D. F., Murray, M., Evans, B., Willig, C., Woodall, & C., Sykes, C. (2005). Health psychology: Theory, research and practice (2nd ed.). Thousand Oaks, CA: Sage. Meichenbaum, D. C., Turk, D. (1987). Facilitating treatment adherence: A practitioner’s guide book. New York: Plenum Press. O’Donohue, W. T., Levensky, E. R. (2006). Promoting Treatment Adherence: A Practical Handbook for Health Care Providers. Chapter 12. Sage Publications. Orr, A., Orr, D., Willis, S., Holmes, M., Britton, P. (2007). Patient perceptions of factors influencing adherence to medication following kidney transplant. Psychology, health & Medicine, 12(4), 509- 517. Wysocki, T., Harris, M. A., Buckloh, L. M., Mertlich, D., Lochrie, A. S., Taylor, A., Sadler, M., Mauras, N., White, N. H. (2007). Effects of behavioral Family Systems Therapy for Diabetes on Adolescents’ Family Relationships, Treatment Adherence and Meabolic Control. Journal of Pediatric Psychology, 31(9), 928- 938. Read More