Compare and contrast the following statements: 'Non-adherence [to medication] The nurse-patient relationship will prove key to effective medication adherence Both set their face against the 'doctor (or nurse) knows best'. Ann Fam Med. Sep-Oct;2(5) Physician-patient relationship and medication compliance: a primary care investigation. Kerse N(1), Buetow S. RNCG Patient Medication Compliance Program Nurses and are experts in their nursing field. supports and facilities the physician/ patient relationship.
After applying inclusion and exclusion criteria and quality assessment, articles were deemed relevant. Peer-reviewed articles, written in English, addressing the relationship between empowerment predictor and medication adherence outcome were included.
Findings High levels of self-efficacy and Internal Health Locus of Control are consistently found to promote medication adherence. External control dimensions were found to have mainly negative Chance and God attributed control beliefs or ambiguous Powerful others attributed control beliefs links to adherence, except for Doctor Health Locus of Control which had a positive association with medication adherence.
Non-adherence has numerous patient, physician, medication and health care system related factors [ 12 ]. Several characteristics of the patients, such as health literacy and medication beliefs influence adherence [ 1 — 4 ]. Empowerment [ 5 ]—as an activating force that motivates some people to take their health behavior and management of illnesses into their own hands—is also one of the patient-related factors.
A collaborative doctor-patient relationship can improve patient empowerment, i.
As a matter of fact, the physicians by facilitating patient engagement in the communication process can foster patient empowerment and better patient outcomes [ 9 ].
Patient empowerment has been associated with positive health and clinical outcomes since the concept made its mark in health care literature [ 51011 ]. The outcomes considered [ 12 ] include improved disease management [ 13 — 17 ], effective use of health services [ 13 — 1518 ], improved health status [ 19 — 21 ], and medication adherence [ 2223 ].
The association between empowerment and positive health behavior and clinical outcomes generally rests on the assumption that patient autonomous activity is beneficial for their health condition. However, in the case of medication adherence, this assumption might not always hold true. Similarly, Bader et al.
On the one hand, these forms of non-adherence are often viewed as necessary, since adherence is favorable only if the medication is beneficial. Indeed, a recent review [ 28 ] investigating the consequences of increasing patient empowerment reported that a high level of patient empowerment had a controversial relationship with adherence.
Some aspects of patient empowerment such as information search and knowledge promote adherence, while others i. These challenges call for all concerned to review the empirical knowledge available on the relationship between empowerment and adherence. A multidimensional conceptualization proposed originally in management literature [ 2930 ], and adapted to the health context by Schulz and Nakamoto [ 31 ], perceives empowerment as a motivational construct, holding that patients participate as autonomous actors in health care decisions and consequentially take increased responsibility for such decisions [ 31 ].
This concept has four components: Meaningfulness refers to the value of activities2. Impact belief in making a differenceand 4. Kleinsinger[ 14 ] noted that noncompliance includes a series of behaviors that fall on a continuum of severity, ranging from the trivial to the catastrophic.
Due to the complexity of the concept of 'noncompliance', it is difficult to define a patient as complying or not. Patient will comply with a part of the treatment. The 'related case' highlights the active patient and the collaboration between two parties.
The term 'adherence' has been adopted mainly by the field of psychology and social sciences as an alternative to the term 'compliance'. Moreover, this term highlights that adoption of recommendation or not, it depends on patients' decision. Other authors from the psychology literature used both terms interchangeably. The term 'adherence' respects patient beliefs and reflects that only receiving medication is not always beneficial. Interestingly, failure to be adherent shouldn't be an excuse to blame only the patient.
Nevertheless, the literature does not indicate how agreement can be reached by both sides.
Physician-patient relationship and medication compliance: a primary care investigation.
Nose[ 25 ] defined non-adherence as the failure to follow a treatment regimen, early termination of treatment and poor implementation of instructions while Nichols-English[ 26 ] noted that non adherence can occur in various forms, such as not having a prescription, not taking the correct dose, or taking at the wrong time, forgetting to take doses, or shortening the therapy.
Concordance The term 'concordance' suggests that patients should take more responsibility even if everyone is not willing to do this. Marinker[ 27 ] defined concordance as: It is an agreement reached after negotiation between a patient and a health care professional that respects the beliefs and wishes of the patient in determining whether, when and how medicines are to be taken. Marston[ 31 ] argued that it is difficult to study compliance as measurable variable because there is no possibility for objective measurements.
From onwards, the NANDA members rejected non-compliance by the classification of nursing diagnoses and claimed that patients should not be partners but have blind obedience to the instructions.
Edel[ 35 ] noted for compliance: Dracup and Meleis[ 36 ] defined compliance as the extent to which an individual chooses behaviors that coincide with a clinical prescription. The regimen must be consensual, that is, achieved through negotiations between the health professional and the patient.
Hess[ 38 ] also supported that patient have to pay attention to treatment regimen and to collaborate with therapists. Hussey and Gilliland[ 39 ] defined compliance as: McGann[ 40 ] commented that: Vivian[ 40 ] claimed that between nurse-patient there is a mutual supportive relation where nurses should help patients to promote compliance while patients should participate in the process. They conclude that the term does not match the nursing profession b rationalization: The authors acknowledge the issue of the shaded connotation of term.
However they continued to use the term when appropriate c acceptance: Nurses—authors use the word 'compliance' without any comment on the controversy about. Patient- therapist interaction Until recently, health care provided with in a 'disease-centered model' according to which decisions about patient treatment were taken by health professionals with little participation of the patient.
Therefore, the likelihood of disagreement with the recommendations of health professionals or the likelihood of ambiguity and imprecision of the recommendations, such as those presented by health professionals, are not dealt with. With the evolution in terminology and the use of term 'adherence', there had been remarked a change towards approach to patient care patient-centered.
Patients have the right to express a different opinion regarding diagnosis and treatment regimen. According to Playle et al. The 'patient-centered- model' has been shown to offer greater satisfaction to the patient and yield better results. According to this approach, patients are treated as collaborators, are deep informed about their health issues, are more involved in planning and decision-making and encouraged to take responsibility in taking care of their health.
Physician-patient relationship and medication compliance: a primary care investigation.
Moreover, the 'patient-centered' approach facilitates the patient-therapist interaction and help patient to be aware of the therapeutic regimen.
Nevertheless, non-compliance is a complex and multi-dimensional problem that includes a number of dynamic behaviors and circumstances. Discussion This article analyzes the terminology of 'compliance', 'adherence' 'concordance' while disclosing the deficiencies of a suitable definition of this phenomenon.
What is the difference between compliance, adherence, and concordance? Compliance suggests a unintentional act of subjection to authority, whereas adherence relates to an intentional act of subscribing to a point of view.
Compliance had became unpopular because of its critical complexion. So alternative terms were sought.
Conceptual analysis of patient compliance in treatment
Terms 'noncompliance' and 'non-adherence' make no distinction between someone who takes some or none of his prescribed treatment. The difference is not just semantic but also reflects the relation between health professionals and patients.
Nurses, even in their efforts to implement the patient-centered approach may not have yet understood the complexity of compliance thus being unable to develop strategies that would help patients to achieve better results.
According to Kyngas et al. Patient-centered care considers patients as an integral part of health care team. Effective communication between personnel and patients is essential. Patients have the chance to make decisions about their care and treatment after being informed and in partnership with medical staff. In contemporary times, where the paternalistic model of care is gradually fading whereas patients' active participation in the process of decision-making, and the needs of patients has emerged to the fore,[ 50 ] evaluation of 'compliance' is a matter of great importance.
More attempts are needed to find a definition that reflects the patient- center approach and patients' active participation in decision making. These limitations preclude assuming that concordance leads to compliance or adherence.
The backbone of the concordance model, according to Vermiere et al. In a qualitative study among diabetics they have found that patients sought greater understanding and appreciation by health professionals of the subjective aspects of living with diabetics.
Adler[ 11 ] goes a step further when he discusses the sociophysiology of caring in the doctor—patient relationship. He infers that besides the justification of a caring doctor patient—relationship on humane grounds, it can also be justified as a direct physiological investment. He speculates that caring as a sociophysiological engagement may provide a unitary concept for understanding the health consequences of social support and the doctor—patient relationship for both doctor and patient.
Conceptual analysis of patient compliance in treatment | Insight Medical Publishing
In the present study our research question is, what are the sociocultural determinants of three dimensions concordance, trust, and patient enablement of the doctor—patient relationship and also what are the inter-relations between these three? We defined doctor—patient concordance as an agreement measured by a set of questions suggested by Kerse et al.
Due to rapid industrialization leading to rural—urban migration, the outpatients were comprised of a large number of migrant populations from rural areas. The timeframe to complete the data collection and entry was two months.
Forty days was set aside for data collection, and 20 days for data entry. The study was conducted during May — June, A cross-sectional study design was used. Both quantitative and qualitative methods were employed. A pilot study was carried out, before the main study, to ascertain the number of patients who could be interviewed properly in a day. Based on the findings of the pilot study the final sample size and methods of sampling were decided.
For example, it was found that in a day, five patients could be interviewed properly, so given the 40 days for data collection, a sample size of subjects was planned. During the data collection period of 40 consecutive working days, five consecutive patients were approached daily in the waiting room of the Outpatient Department OPD of the medical college hospital. They were explained the purpose of the study and then invited to give a written informed consent to participate in the study.
The respondents were interviewed using the survey instruments immediately after their consultation with the doctor.
Quantitative methods Three dimensions of the doctor—patient relationship were examined, that is, physician—patient concordance agreementtrust, and patient enablement. Measurement techniques for these aspects are given below. Study instruments Part I of the survey instrument elicited health, demographic, and sociocultural information. Part II of the survey instrument assessed various aspects of the doctor—patient relationship, such as: The agreement between doctor and patient was assessed with the following questions: Results for all the six questions were then summed to give a cumulative score between 0 and 6, with higher scores indicating greater concordance.
In the present study those scoring 5 and 6 were taken as having complete agreement or concordance and the rest as partial concordance.
Trust in physician Trust in the doctor was measured by the Trust in Physician Scale,[ 12 ] which yielded a score ranging from lowest to highest on the Likert Scale, with the higher scores indicating more trust.
In the present study, the highest two possible values were taken as complete trust in the physician and the rest of the scores were categorized as partial trust. Patient enablement This was measured by using the Enablement Index. This index, validated in primary care against patient satisfaction, asked whether the patients were more or less able to cope with life, understood and coped with their illness, and helped themselves as a result of the consultation with the physician.
The responses were scored from 1 to 4, with higher scores meaning more enablement.