Non adherence diabetes

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Non adherence in DiabeticsAn attitude and behaviour study

2013 studyBy Brandcare

Medicines don't workif people don't take them

And yet they are the most neglected

Excuses take many forms!

Mehenga hai.

Bahut garam padta hai

I didn't understand the directions

I am feeling much

better. God bless the

doctor!

Mr. Sharma was

asked to stop

after a month

It’s not available nearby

I forgot!

Buaji had Side effects

I am so busy.

Chalta hai. Hota hai.

I didn’t know how long to take

Estimates of medication nonadherence rates typically range from 30% to 60%,

when medication was to be taken over a long period, compliance rates dropped dramatically to approximately 50% for either prevention or cure.

Meichenbaum D, Turk DC. Facilitating Treatment Adherence: A Practitioner's Guidebook. New York: Plenum Publishing Corp; 1987

Sackett DL, Snow JC. The magnitude of compliance and noncompliance. In: Haynes NRB, Taylor DW, Sackett DL, eds. Compliance in Healthcare. Baltimore: Johns Hopkins University Press; 1979:11-22

Disease Condition

Treatment

Demographics

Physician Attitudes

PatientAttitudes

The most impact able of these are

Hence Brandcare decided to study non-adherence from attitude perspective

We studied the attitudes of Indian Patients and Physicians towards non-adherence in Diabetes

Attitudes are contagious

Non adherence in DiabeticsAn attitude and behaviour study

2013 studyBy Brandcare

Source:1. WHO. 2003a. Adherence to long-term therapies: evidence for action. Geneva: World Health Organisation

WHO defines adherence as:

Defining non-adherence

The extent to which a person’s behavior – taking medications, following a diet and/ or executing lifestyle changes - corresponds with agreed recommendations from a health care provider”

Non- adherence a difference in perspectives!

Physician believes that adherence has improved over the past years

Past 5 years

24%47%

65%

Estimated non-adherence

according to patients

24%

Estimated non-adherence

according to physicians

Types of non-adherence and incidence

Short term

Long term

Medium term

50%49%

0-1%*Almost no patient reported permanent discontinuation of medicine without consulting physician, hence assumed 0

Of the 64% non-adherent population,

According to the study the belief and behavior factors affecting non adherence can be categorized into intentional and unintentional

*Represents views of “out of every 10 patients”. Total patient surveyed 120

Intentional

Unintentional

*Represents views of “out of every 10 patients”. Total patients surveyed: 120

The difference in Physician and Patient perspectives

Physician

Patient

Patient thinks his own efforts, understanding and physician patient communications are most important aspects affecting adherence

Physicians think patient’s own efforts put in, understanding, affected degree impact adherence

Adherence in chronic conditions is an

ACUTE problem after all!

Belief and Behavioral factors have direct impact on adherence, key adherence influencing factors identified are:

Understanding(Knowledge of disease and condition )

Communication(Interaction quality with physicians)

Affected(Uncertainty / concern related to disease / treatment)

Trust(Faith on effect / safety of medications)

Effort(Self-involvement to manage disease)

Patient respondent response recorded on the above five impacting factors were recorded on a scale of 1 to 5. Response analysis helped us categorize patients into following six categories:

Patient Profiling

Disciplined

Patient Profiling

Very well organised and determined to achieve their goals. All their efforts are driven in a similar direction, may that be eating, work or any other schedule to be followed. They like to do things well in time and have fixed patterns for a day. They have an inner calm and an outer resolve. They are honest, controlled and cannot be easily wavered in their decisions.

Eager, confident and proactive in managing Disease, overall health

Disciplined

Patient Profiling

30% 70%

% of total sample % adherent

Confident

Patient Profiling

He has faith in himself in all his endeavors. He tries doing things on time but whatever he does, he is filled with a deep sense of inner trust. He is open about possibilities and aspirations to be pursued. He’s aware of his overall state of well being and feels confident about himself. He is aware of his thoughts and feelings and is committed to his own purpose.

Eager and knowledgeable but have low trust in physician and medications. They think they know best.

Confident

15% 50%

% of total sample % adherence

Worried

Patient Profiling

She is non-assertive in most of her daily regimen too and withdraws from a lot of situations. If she gets too concerned about a certain thing, then she can’t concentrate on the task at hand. She is also reluctant to communicate the concern and tends to get distracted from important matters.

Knowledgeable, concerned about diseases but prefer lifestyle changes over medication

Worried

15% 40%


Confused

Patient Profiling

He is a person who is indecisive by nature, and might even come across feeling of disorientation in a certain situation, getting away from it. It is difficult for him to trust someone and is therefore detached and disengaged at times. He is also quite judgmental about all possibilities.

Confused about disease, doctor’s advice and recommendations. Lacks trust in medication and concern for health is negligible

10% 40%


Confused

Laid back

Patient Profiling

He is mostly relaxed by nature and takes things lightly. He is an easy going person who tends to go with the flow. He enjoys life to the fullest and believes living in the moment. He is not affected soon by situations.

They are afraid of the consequences but are too lazy to act and are generally careless about their health

15% 30%


Laid back

Doubter

Patient Profiling

He is a kind of person who is very perception led and is hesitant in various situations that he comes across. May that be studying, work or life; his tendency to doubt doesn’t leave him. Is generally surrounded by low sense of faith on people around him and takes him quite some time to build the same. He might have different or even absurd views in different situations.

Their knowledge on disease, treatment is confounded. They make their regimen to suit their schedule and do not follow advice.

15% 0%


Doubter

Patient adherence is a complex fallout of attitudes and behaviour. Solutions to counter non-adherence should consider this. A one size fits all approach may not work.

customisation may be the key to improving overall adherence!

Customised modules and tools through screening, diagnoses and treatment steps can be developed

..towards better chronic care together

Call us to create better patient adherence programs for you