NRSG372 Principles Of Nursing Chronic Illness And Disability

Slide 1 – Introduction

The field of medical science is useful for the people who need medical assistance and need to recover from a chronic disease. Patients who suffer from chronic disease such as diabetes, hypertension, obesity, and cardiovascular diseases need to follow their medication management for a speedy recover. It also ensures low healthcare cost, less burden on the healthcare industry, and more functional abilities. A proper routine of medication has to be explained by the practitioner and followed by the patient for complete medical adherence. A number of factors affect the adherence of medications that include patient-provider communication, personal issues of the patient, lack of knowledge in the provider, and drug tolerance issues (Pasina et al., 2014). Strategies to improve medical adherence should be utilized to decrease the barriers for patients who are unable to adhere to the medical guidelines. Suitable techniques need to be adopted so that this medical issue can be controlled and patients who are not able to follow the protocols of the prescription can use better techniques. The role of the healthcare professionals is crucial in this whole aspect because they are knowledgeable about the medications and the type of patients who are prescribed (Vrijens et al., 2017). This includes the nurses, general practitioners, pharmacists and the physicians who can improve medical adherence of the patients.

Slide 2- Consequences

The issue of medical non-adherence is described by the World Health Organization as “the degree to which the person’s behaviour corresponds with the agreed recommendations from a health care provider”. A number of factors are involved in the non-adherence of medications, which includes primary non-adherence, non-persistence by the patients, and non-conforming by the patients. These are the causes of medical non-adherence, which is elevated by the patients but several factors are elevated by the healthcare providers. The consequences of medical non-adherence includes disease progression, low quality of life, decrease in functional abilities, increase in healthcare costs, and dilemma for the patient and their family to consecutively visit medical care (Brown et al., 2016). They effort of the health experts as well as the closed ones goes into vain if the medical treatment is not working. According to the literature review on medical non-adherence, the effect on health is severe if the prescribed medicines are not being consumed to recover from chronic diseases. Patients with diabetes, hypertension, and cardiovascular diseases who do not adhere to the prescribed medicines are more likely to get admitted to hospitals than those who follow medical adherence (Cutler et al., 2018). People are open to emergency hospitalizations who have poor adherence to medication and disease management. Wastage of medication is another aspect that increases the consequences of medical non-adherence, which affects the pharmacy industry. This also elevates the healthcare cost because the medicine goes to waste, and the pressure of paying expensive medical bills also increase. It is better to follow the instructions of the healthcare providers and adhere to the medical prescriptions given by them (Iuga & McGuire, 2014).

Slide 3

Medical non adherence increases due to the irresponsibility or lack of knowledge in healthcare providers, which is a significant reason for non-adherence of the patients. It is necessary to look into the aspect of outcomes of burden in the healthcare industries due to medical non-adherence as it is a public health concern. The healthcare providers should make sure that they are educating the patients about the importance of following the prescription. However, in certain situations the healthcare provider becomes an obstruction for the patient to follow the medical guidelines. One of the reason is poor communication with the patient, which includes language barriers, cultural differences, temperament issues, and communication gap due to disabilities. People with chronic conditions should be taken into consideration while explaining about their medical dosages and timings (Kvedar, Coye & Everett, 2014). Poor communication between patient and provider results to the negligence of the patient in regard to medical adherence. The second reason is the dissatisfaction of the patients due to the behaviour of the healthcare provider, which makes the patient feel that they should not obey the orders of their practitioner. A misconduct or evidences of lack of knowledge in front of the patient causes doubt and fear in patients, and this is why they do not adhere to the medical prescription given by the healthcare provider. A high patient-provider discordance leads to the decrease in patient satisfaction, and after the visit from a doctor they tend to feel that those medicines will not help them to recover. The patients also misunderstand the instructions due to their preconceived notions, which should be considered by the provider. The third reason is inefficient follow ups with the patient, which is due to the improper explanation of the prescription to the patient or the carer when they visit for the follow up. Patients with chronic disease usually have a complex medical routine, and this is the responsibility of the provider to make sure that they explain every drug administration, intervals, dosage, and timings in the best possible way. Various medications can confuse the patient and it can cause medical non-adherence (Yap, Thirumoorthy & Kwan, 2016).

Slide 4

The negligence of the healthcare provider has to be decreased through suitable and effective strategies that includes therapeutic communication, providing patient questionnaires and taking feedbacks, and educating the carer of the patient about their drug administration during a follow up. These strategies will improve the condition of the patient by letting them following the medical guidelines (Smith et al., 2017). The healthcare providers in a medical set up need to follow the medical procedures and use their communication skills to eradicate this issue because it has been creating health complications for patients with chronic disease. The providers should include patients in decision making for their medication as this will give them a feeling of ownership and it will also improve therapeutic communication. The healthcare provider should actively listen to the inputs of the patients, which will engross the patient into the conversation and this will increase their understanding of their medication (Lam & Fresco, 2015). The patient should be informed about the side effects and usage of the medication. This will elevate the chances of following the prescription because they will know why they are consuming the medicine. The explanation of the medication should be done according to the understanding abilities or the literacy level of the patient.

Slide 5- Evaluation

These strategies used by the healthcare providers has to be evaluated through techniques to ensure its validity. One of the technique is the direct observed therapy in which the drug metabolites are investigated in the blood and urine. It also measures the biological marker, which is added to the drug formulation, and this can be tested through the blood sample of the patient (Costa et al., 2015). This is the most accurate method but it is also expensive. Another method includes giving questionnaires to patients to take a feedback regarding their medical adherence. This will make it clear if they are following the protocol or not. The most simple way to measure medical adherence is through patient self-reports as it gives the medical summary of the patient. An indirect method to evaluate medical adherence includes pill counting, assessment of patient’s clinical response, physiologic marker measurements, and electronic medication monitors. All of these methods have its own advantages and disadvantages but it is the responsibility and understanding of the nurse to use them for the best interest.

Slide-6 Conclusion

The issue of medical non-adherence has been affecting the health of patients worldwide, which shows that the healthcare providers should take appropriate measures to prevent and eradicate this issue. Several factors causes the elevation of medical non-adherence and this proves that the patient and the physician are responsible for this complication. However, healthcare providers are more responsible for this situation because educating patients and making them follow medical adherence is the duty of the healthcare industry. This complication can be decreased with the help of multidisciplinary approach who can support patients as well as the people who are involved in medication use.

References

Brown, M. T., Bussell, J., Dutta, S., Davis, K., Strong, S., & Mathew, S. (2016). Medication adherence: truth and consequences. The American journal of the medical sciences, 351(4), 387-399.

Costa, E., Giardini, A., Savin, M., Menditto, E., Lehane, E., Laosa, O., … & Marengoni, A. (2015). Interventional tools to improve medication adherence: review of literature. Patient preference and adherence, 9, 1303.

Cutler, R. L., Fernandez-Llimos, F., Frommer, M., Benrimoj, C., & Garcia-Cardenas, V. (2018). Economic impact of medication non-adherence by disease groups: a systematic review. BMJ open, 8(1), e016982.

Iuga, A. O., & McGuire, M. J. (2014). Adherence and health care costs. Risk management and healthcare policy, 7, 35.

Kvedar, J., Coye, M. J., & Everett, W. (2014). Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth. Health Affairs, 33(2), 194-199.

Lam, W. Y., & Fresco, P. (2015). Medication adherence measures: an overview. BioMed research international, 2015.

Pasina, L., Brucato, A. L., Falcone, C., Cucchi, E., Bresciani, A., Sottocorno, M., … & Nobili, A. (2014). Medication non-adherence among elderly patients newly discharged and receiving polypharmacy. Drugs & aging, 31(4), 283-289.

Smith, D., Lovell, J., Weller, C., Kennedy, B., Winbolt, M., Young, C., & Ibrahim, J. (2017). A systematic review of medication non-adherence in persons with dementia or cognitive impairment. PloS one, 12(2).

Vrijens, B., Antoniou, S., Burnier, M., de la Sierra, A., & Volpe, M. (2017). Current situation of medication adherence in hypertension. Frontiers in pharmacology, 8, 100.

Yap, A. F., Thirumoorthy, T., & Kwan, Y. H. (2016). Medication adherence in the elderly. Journal of Clinical Gerontology and Geriatrics, 7(2), 64-67.