Research Paper on "Non-Compliance in Patients"

Research Paper 15 pages (4937 words) Sources: 10 Style: APA

[EXCERPT] . . . .

Patient Noncompliance

Noncompliance in Patients

Advanced Practice Nursing represents a partnership between the patient and service provider. Many times the success of the treatment plan depends on the patient taking responsibility for compliance with certain prescribed actions. Examples of these actions include taking prescribed medication as directed, following a certain diet, or following an exercise regimen. If a patient does not follow the treatment plan, it can jeopardize the outcome of the treatment. Many physicians and other medical practitioners now view patient noncompliance as a breach of the relationship.

The practice of "firing" patients that do not follow recommended advice is becoming more common. This research will explore the practice of terminating patients for lack of compliance to prescribed medical treatments. It will explore the ramifications of this practice for the patient and for the medical practice. It will explore alternatives to firing a patient and steps that can be taken by the nurse practitioner to help avoid this unfortunate event.

Factors Affecting Patient Noncompliance

The American Medical Association supports the practice of firing a patient for failure to follow prescribed medical procedures. The American Academy of Nurse Practitioners defines the relationship as that of helping clients to make wise health and lifestyle choices. They recognize the relationship as a partnership, rather than a service. This research explores the ethics involved in terminating the patient/client relationship when the patient fails to follow sound medical advice.

When a patient chooses not to follow prescribed treatment regimens, it can have serious affects on their health. It may reduce their quality of life, or may lead to increased morbidity or death in some cases (Rosner, 2006). These issues make the topic of patient noncompliance an important issue for medical professionals. Noncompliance with treatment plans can lead to increased costs due to worsening conditions, or the development of new conditions or complications. Noncompliance has medical and financial implications.

Often nurse practitioners and other medical personnel are at a loss to understand the reasons for patient noncompliance. However, there are often reasons for a patients actions or lack of action during the treatment plan. Understanding these reasons will help nurse practitioners to be able to predict those patients that are at risk for noncompliance and develop ways to help them follow their treatment regime. Recently, a considerable amount of academic research concerning the prevalence and reasons for patient noncompliance has been produced. The following summarizes the latest findings regarding patient noncompliance among various health disciplines. Many of these studies are targeted towards doctors, but they still apply to nurse practitioners, or any other health professional that must interact with patients on a regular basis.

Often information regarding medication history relies on self-reporting by the patient. Among heart patients, compliance with the treatment regime can be important to preventing future heart related incidents. In a recent study, blood samples were taken from patients upon admission to the hospital. The purpose of the study was to determine if information regarding medication use by patients matched medication levels found in the blood system (Glintborg, Hillestrom, & Olsen et al., 2007). Results indicated that only 2% of the patients reported use of drugs that were not found in their system. However, six percent of the patients had drugs in their system that was not reported prior to the blood draw (Glintborg, Hillestrom, & Olsen et al., 2007). The study concluded that a majority of the patients provided accurate information to health care professionals and that only a small percentage misrepresented their medication history. However, those patients that did not report other medications that they were taking are of particular concern due to the possibility of a harmful drug interaction.

In a similar study, noncompliance with heart medication regimes was defined as failure to comply at least 75% of the time (Gehi, Ali, & Na et al., 2007). Noncompliance was found to lead to a significant increase in coronary events as compared to patients that complied with the prescribed regime (Gehi, Ali, & Na et al., 2007). The reasons for patient noncompliance are not well understood and a number of factors contribute to noncompliance in patients.

Ho, Spertus, Masoudi & associates (2006) found several demographic factors that correlated with patient discontinuation of medication after myocardial infarction. Those that did not graduate from high school were more likely to discontinue at least one of three medications prescribed. Increasing age was also associated with medicine discontinuation. Females were more likely than males to discontinue at least one medication (Ho, Spertus, & Masoudi et al., 2006). This study also corresponded with Gehi, Ali & Na et al. (2007) in that patients who discontinued their medication had a significantly lower one-year survival than patients that followed the prescribed medication regime. Therefore, it is important to stress the need to follow prescribed treatments.

Patients prescribed thienopyridine therapy after placement of a heart stent were likely to discontinue treatment after only 30 days or less (Spertus, Kettelkamp, & Vance et al., 2006). Discontinuation of this therapy was associated with death within 11 months, due to complications (Spertus, Kettelkamp, & Vance et al., 2006). This study found similar demographic risk factors to Spertus, Kettelkamp, & Vance et al., (2006) in noncompliant patients. They found that those with lower educational levels, older patients, and married patients were less likely to comply with prescribed medication regimes. Another fact found in this study was that cost, preexisting cardiovascular disease, and anemia were factors in noncompliant patients. One of the key concerns raised in this study was that many patients that discontinued their medication had not received discharge instructions prior to leaving the hospital. They also had not received referral for cardiovascular rehabilitation (Spertus, Kettelkamp, & Vance et al., 2006).

Many studies address rates of noncompliance, but little attention has been directed towards discovering the reasons for noncompliance. Chatterjee, (2006) found that the quality of the doctor/patient relationship plays a significant role in outcomes regarding noncompliance. In the past, the doctor may have viewed the patient as less knowledgeable and therefore, the less knowledgeable of the two in terms of treatment decisions. Patients felt as if they were being dictated or given orders by the doctor.

It is now recognized that the patient has the right to make decisions about their own health and treatment. This developed into the idea of "concordance" (Chatterjee, 2006). Under this relationship model, the patient is viewed as an equal and has the right to make informed decisions. Patients with concordance in the doctor/patient relationship were more likely to follow prescribed diabetes management routines than those that lacked concordance in their doctor/patient relationships (Chatterjee, 2006).

In asthma patients, low rates of adherence to asthma self-management regimes were linked to the patient feeling that treatment was unnecessary (Horne, 2006). Asthma patients were also concerned about the long-term adverse affects of corticosteroids (Horne, 2006). Local symptoms that were considered intolerable also affected patient noncompliance with asthmas self-maintenance regimes (Horne, 2006). These reasons for noncompliance represent legitimate concerns and remind us that the noncompliance issue is not one-sided. Medical professionals need to address legitimate concerns such as these in order to increase patient compliance with prescribed medication regimes.

Depression was found to be a factor in discontinuation of medication adherence in patients with coronary heart disease (Gehi, Haas, & Pipkin et al., 2005). Renal transplant patients were found to comply with immunosuppressant therapy after transplant surgery (Chisholm, Lance, & Mulloy, 2005). Sex of the patient was not found to be a factor in noncompliance within this group. However, patient age, income, and time since the implant procedure were found to affect compliance rates in this group of patients (Chisholm, Lance, & Mulloy, 2005).

Pharmacist instruction did not increase patient compliance in patients with uncontrolled diabetes (Odegard, Goo, & Hummel et al., 2005). A significant number of patients beginning medication for a number chronic conditions including stroke, coronary heart disease, asthma, diabetes, and rheumatoid arthritis, quickly became noncompliant with their medication regimes (Barber, Parsons, & Clifford et al., 2004). Noncompliance in this group occurred in as little as ten days after prescription. Patients cited medication problems and a lack of information as key factors in their decision to discontinue medication as prescribed (Barber, Parsons, & Clifford et al., 2004). Some of the patients that reported no problems and were compliant in the beginning later developed problems and had discontinued medication by the four-week mark. These studies highlight the need for support for patients beginning a new medication regime.

Noncompliance in women with fibromyalgia was predicted by several factors. Those not under a rheumatologist's care were less likely to continue therapy, as were those with less disease activity (Sewitch, Dobkin, & Bernatsky et al., 2004). Instrumental coping mechanisms increased the likelihood of compliance in patients (Sewitch, Dobkin, & Bernatsky et al., 2004). Problems with the doctor/patient relationship were found to be at the heart of many noncompliant women in the study. These patients were divided into compliant, intentionally noncompliant, and unintentionally noncompliant. Those that were unintentionally noncompliant often cited costs or… READ MORE

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