3.3 ADHERENCE TO MEDICAL ADVICE

Reasons for non adherence Key study: Bulpitt and Fletcher (1988)Aim To review research on adherence in

hypertensive patients.

Method Review article of research identifying

problems with taking drugs for high blood pressure.

Procedure

Research was analysed to identify the physical and psychological effects of drug treatment and the adherence rates of patients.

Findings

There are many side effects of taking anti-hypertension medication. In one study by Curb (1985) 8% of males

discontinued treatment because of sexual problems.

Research by the Medical Research Council (1981) found that 15% of patients had withdrawn from taking medication due to side effects.

Conclusion

When the costs of taking medication, such as side effects, outweigh the benefits of treating a mainly asymptomatic problem such as hypertension, there is less likelihood of the patient adhering to their treatment.

Measuring adherence Key study: Lustman et al. (2000)

Aim To assess the efficacy of the anti-depressant

fluoxetine in treating depression by measuring glycemic control.

Method A randomised controlled double-blind study.

Participants

60 Patients with type 1 or type 2 diabetes and diagnosed with depression.

Procedure

Patients were randomly assigned to either a fluoxetine or a placebo group.

Patients were assessed for depression using psychometric tests and their adherence to their medical regimen was assessed by measuring their GHb levels, which indicated their glycemic control.

Findings

Patients given fluoxetine reported lower levels of depression.

Patients given fluoxetine had lower levels of GHb, which indicated their improved adherence.

Conclusions

Measuring GHb in patient with diabetes indicates their level of adherence to prescribed medical regimes.

Greater adherence was shown by patients who were less depressed.

Improving adherence Key study: Watt et al. (2003)Aim To see if using a Funhaler® could improve

children’s adherence to medication for asthma.

Method

A field experiment, although it used children with asthma so could also qualify as a quasi-experiment. The experiment set up two conditions, and then used self-report to measure the adherence rates.

Participants

32 Australian children with asthma: 10 males and 22 females; aged from 1.5 to 6 years; mean age 3.2 years.

Design A repeated design as each participant

had one week using the normal inhaler then one week using the Funhaler.

Procedure

Each child was given the Breath-a-Tech to use for one week, and a questionnaire was given for the parents to complete.

In the second week, the children used the Funhaler, and the parents were given a matched questions questionnaire.

Findings

38% more parents were found to have medicated their children the previous day when using the Funhaler compared to the normal inhaler.

Conclusions

The Funhaler reinforced correct usage of the inhaler with a toy that spins and a whistle that blows.

This did improve the adherence to the medication.

By making the medical regime fun, the adherence, certainly in children, can be improved.