From Compliance to Adherence in Diabetes Self-Care: Examining the Role of Patient’s Potential for Mindful Non-Adherence and Physician-Patient Communication
Abstract:Purpose: To examine the roles of patient mindful non-adherence and physician-patient communication as important factors that facilitate an understanding of the relationship between compliance and adherence in diabetes management.
Design: A cross-sectional survey
Setting: Online data collection
Subjects: 365 respondents at least 18 years of age and currently in treatment for diabetes
Measures: We measured patients’ compliance, adherence, mindfulness, and perceptions about physician-patient c… Show more
“…Сложившееся к началу текущего столетия терминологическое многообразие, описывающее отношение пациента к исполнению медицинских предписаний, впоследствии продолжало расширяться, как за счет введения в оборот синонимов, так и за счет придания определениям смысловых www.jscientia.org нюансов. С другой стороны, во многих источниках термины комплаенс, приверженность и близкие к ним стали использоваться как взаимозаменяемые синонимы [1,[9][10][11].…”
Adherence to treatment is understood as a complex model of the patient’s behavior in relation to their health, implemented in the degree of compliance of such behavior with respect to the recommendations received from the doctor regarding medications, self-control algorithms, diet and other lifestyle change measures. Adherence can be assessed by determining drug metabolites in body fluids (blood, urine) and using various questionnaires. At the same time, an important role in increasing adherence to therapy is assigned to the attending physician, without contact with which most patients make an independent decision to stop taking all or some of the prescribed drugs or to make an unreasonable correction of their dosages. Among the factors influencing the decrease in adherence to treatment of cardiac patients are the patient’s misunderstanding of their disease and the expected effects of therapy, fears of undesirable effects of therapy, a low level of motivation, a tendency towards forgetfulness and some others. Comorbidity and related polypharmacy also contribute to non-adherence, especially multiple drugs are prescribed simultaneously by various specialists — therapists, endocrinologists, urologists, neurologists, ophthalmologists. At the same time, there is a clear increase in undesirable consequences (repeated hospitalizations due to myocardial infarction and other cardiovascular events) in non-adherent patients 6 months after the previous coronary event and a significantly higher risk a year later. Increasing adherence to treatment is the task of medical workers, starting from the inpatient stage of treatment (clear recommendations noted in the discharge documents), followed by the support of outpatient doctors, explaining the need to take certain medications, and ending with monitoring the execution of medical prescriptions.
“…Сложившееся к началу текущего столетия терминологическое многообразие, описывающее отношение пациента к исполнению медицинских предписаний, впоследствии продолжало расширяться, как за счет введения в оборот синонимов, так и за счет придания определениям смысловых www.jscientia.org нюансов. С другой стороны, во многих источниках термины комплаенс, приверженность и близкие к ним стали использоваться как взаимозаменяемые синонимы [1,[9][10][11].…”
Adherence to treatment is understood as a complex model of the patient’s behavior in relation to their health, implemented in the degree of compliance of such behavior with respect to the recommendations received from the doctor regarding medications, self-control algorithms, diet and other lifestyle change measures. Adherence can be assessed by determining drug metabolites in body fluids (blood, urine) and using various questionnaires. At the same time, an important role in increasing adherence to therapy is assigned to the attending physician, without contact with which most patients make an independent decision to stop taking all or some of the prescribed drugs or to make an unreasonable correction of their dosages. Among the factors influencing the decrease in adherence to treatment of cardiac patients are the patient’s misunderstanding of their disease and the expected effects of therapy, fears of undesirable effects of therapy, a low level of motivation, a tendency towards forgetfulness and some others. Comorbidity and related polypharmacy also contribute to non-adherence, especially multiple drugs are prescribed simultaneously by various specialists — therapists, endocrinologists, urologists, neurologists, ophthalmologists. At the same time, there is a clear increase in undesirable consequences (repeated hospitalizations due to myocardial infarction and other cardiovascular events) in non-adherent patients 6 months after the previous coronary event and a significantly higher risk a year later. Increasing adherence to treatment is the task of medical workers, starting from the inpatient stage of treatment (clear recommendations noted in the discharge documents), followed by the support of outpatient doctors, explaining the need to take certain medications, and ending with monitoring the execution of medical prescriptions.
“…Soyoon & Ekaterina (19) argue that when patients effectively engage in self-care behaviors, they can better connect with their bodies. Mindfulness brings awareness to the present moment and bodily sensations, including both pleasant and unpleasant feelings, through meditation practices or physical awareness.…”
: The present research aimed to predict treatment plan adherence based on mindfulness and self-efficacy beliefs in patients with chronic pain. This cross-sectional and correlational study focused on all patients with chronic pain who visited Shahid Rajaei and Shahid Madani Hospitals in Karaj during the last six months of 2022. A total of 150 individuals were selected using the convenience sampling method. Data were collected through the Demographic Information Checklist, Mindfulness Questionnaire, General Self-efficacy Scale (GSE), and Treatment Plan Adherence Questionnaire. Data analysis was performed using descriptive statistics, correlation coefficient tests, and multiple regression analysis with SPSS 26. The results revealed a significant positive correlation between mindfulness (r = 0.642, P < 0.012) and self-efficacy beliefs (r = 0.669, P < 0.010) with treatment plan adherence. Furthermore, regression analysis indicated that the predictive variables together explained 31% of the variance in treatment plan adherence scores in patients with chronic pain (P < 0.05). Therefore, timely and appropriate interventions and education that enhance self-efficacy beliefs and mindfulness in patients with chronic pain can improve treatment plan adherence.
“…In diabetes care, goal setting is generally conducted by physicians who collaborate with patients to set short-term and specific goals[ 58 ], such as diet-related goals[ 59 ], and feedback is also provided by physicians. Patients and doctors are usually involved in established partnerships and collaborations[ 60 ]. Evidence has shown that a patient-empowerment approach using collaborative goal setting improves A1C[ 61 ].…”
We still do not have comprehensive knowledge of which framework of patient-centered care (PCC) is appropriate for diabetes care, which elements of PCC are evidence-based, and the mechanism by which PCC elements are associated with outcomes through mediators. In this review, we elaborate on these issues. We found that for diabetes care, PCC elements such as autonomy support (patient individuality), cooperation and collaboration (system-level approach), com-munication and education (behavior change techniques), emotional support (biopsychosocial approach), and family/other involvement and support are critically important. All of these factors are directly associated with different patient outcomes and indirectly associated with outcomes through patient activation. We present the practical implications of these PCC elements.
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