Reasons for non-adherence
The drugs don't
work: a modern
medical scandal
 Why do people listen to doctors then if drugs do
not work?
 Adherence is important issue – evidence shows
generally adherence rates are low.
 Simons et al (96) shows that even for...
 Looking at the cognitive decision making process
that people go through in order to decide to take
medication
 Linked t...
 Studies have suggested
that about half the patients
with chronic illnesses such
as diabetes and
hypertension (high blood...
 50% of patients in America did
not take prescribed
medications according to the
instructions and scheduled
appointments ...
Taylor (1990) suggested that 93% of patients fail to adhere to some aspect ofTaylor (1990) suggested that 93% of patients ...
 He studied 50 patients for
7 months. After detection
of high blood pressure
only 50%-70% sought
treatment
 He found tha...
 Rational Choice Theory: people may notRational Choice Theory: people may not
adhere for good reason:adhere for good reas...
 The patient may not believe
what the doctor has
suggested is in their best
interest. Bulpit (1988)Bulpit (1988)
looked a...
AimsAims:
To review research on adherence in hypertensive
male patients.
Hypertension has no real short-term effects
but ...
ProcedureProcedure:
Research analysed to identify the physical and
psychological effects of drug treatment on person’s
lif...
Findings:Findings:
Anti hypertensive drugs have many side effects
including sleepiness, dizziness, lack of sexual
function...
ConclusionsConclusions
The costs of taking some medication appear to outweigh
the benefits for many patients, especially w...
 The more a person feels in control the more likely
they are to comply with their treatment
programme.
 If we have an in...
 PsychoanalyticPsychoanalytic explanations include avoidance
and denial of the problem
Think back to Freud and his defenc...
A review article gives data that covers many
countries and gives a overall view of the effects
of taking medicine for hype...
 Psychology as a science: single blind testing and
randomisation helps to show the real effects of
medication
 Usefulnes...
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    1. 1. Reasons for non-adherence
    2. 2. The drugs don't work: a modern medical scandal
    3. 3.  Why do people listen to doctors then if drugs do not work?
    4. 4.  Adherence is important issue – evidence shows generally adherence rates are low.  Simons et al (96) shows that even for Statins (drugs to reduce cholesterol which have few side effects) adherence rate is only 70%.
    5. 5.  Looking at the cognitive decision making process that people go through in order to decide to take medication  Linked to HBM – cost & benefit analysis. If costs outweigh benefits the logical decision is not to take medication.
    6. 6.  Studies have suggested that about half the patients with chronic illnesses such as diabetes and hypertension (high blood pressure) are non-compliant with their regime. There is clearly a large financial cost for this in wasted drugs but also potentially in poor health outcomes.
    7. 7.  50% of patients in America did not take prescribed medications according to the instructions and scheduled appointments for treatment were missed 20-50% of the time.  Where compliance means going against well established habits and going against strong motives (e.g. giving up smoking) compliance is even worse.
    8. 8. Taylor (1990) suggested that 93% of patients fail to adhere to some aspect ofTaylor (1990) suggested that 93% of patients fail to adhere to some aspect of their treatment.their treatment. Sarafino(1994) argued that people adhere reasonably closely about 78% of theSarafino(1994) argued that people adhere reasonably closely about 78% of the time for short-term treatments but only 54% for chronic illness.time for short-term treatments but only 54% for chronic illness. A study by Becker (1972) looked at whether a prescribed anti-biotic was beingA study by Becker (1972) looked at whether a prescribed anti-biotic was being taken halfway through a 10 day treatment programme in young children. Overtaken halfway through a 10 day treatment programme in young children. Over half the mothers had stopped giving the medicine.half the mothers had stopped giving the medicine.
    9. 9.  He studied 50 patients for 7 months. After detection of high blood pressure only 50%-70% sought treatment  He found that only 65% of pills were taken.  Only 20% of the patients took as many as 90% of the pills.  33% of those who sought treatment dropped out.  The question is why?
    10. 10.  Rational Choice Theory: people may notRational Choice Theory: people may not adhere for good reason:adhere for good reason: 1. They have reason to believe the treatment is not working 2. The side effects are unpleasant or effect the quality of their lives YouTube - Ambien Side Effects -- Research Finding 3. There are practical barriers to the treatment such as cost or social difficulties 4. They may want to check the illness is still there when they stop.
    11. 11.  The patient may not believe what the doctor has suggested is in their best interest. Bulpit (1988)Bulpit (1988) looked at treatments for hypertension and found that the side effects could include impotence and problems with ejaculation. Clearly for some men this would be seen as unacceptable!
    12. 12. AimsAims: To review research on adherence in hypertensive male patients. Hypertension has no real short-term effects but in the long term can lead to heart disease and stroke Method:Method: Review article of range of research which identified problems with taking drugs for high blood pressure.
    13. 13. ProcedureProcedure: Research analysed to identify the physical and psychological effects of drug treatment on person’s life.
    14. 14. Findings:Findings: Anti hypertensive drugs have many side effects including sleepiness, dizziness, lack of sexual functioning. They also affect cognitive functioning and so work and hobbies may be curtailed Bulpitt reported that one study by Curb found that 8% of men stopped taking their medication due to sexual problems. He also reported that research by the Medical Research Council found that 15% of patients had stopped taking the drug due to other side effects.
    15. 15. ConclusionsConclusions The costs of taking some medication appear to outweigh the benefits for many patients, especially with problems such as high blood pressure which have no symptoms. Therefore some types of treatment (asymptomatic ones) may be more difficult to treat as people cannot feel the benefits of the adherence.
    16. 16.  The more a person feels in control the more likely they are to comply with their treatment programme.  If we have an internal locus of control we are likely to have a higher self efficacy – more belief in what we do makes a difference.
    17. 17.  PsychoanalyticPsychoanalytic explanations include avoidance and denial of the problem Think back to Freud and his defence mechanisms how can you relate this to non adherence to medical advice?
    18. 18. A review article gives data that covers many countries and gives a overall view of the effects of taking medicine for hypertension. No two studies use the same method so is not reliable Survey data can be inaccurate. Demand characteristics to look like a ‘ good patient’
    19. 19.  Psychology as a science: single blind testing and randomisation helps to show the real effects of medication  Usefulness: allows practitioners and patients aware of the side effects of the medication for males with hypertension.

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