Download Patient Uncompliance in Diabetes

Patient Uncompliance in Diabetes
Prof. Morsi Arab
Definition: comply= agree/ yield
Consequences :
1- immediate conseq. can be serious ;
eg. Ketoacidocis , hypoglycaemia ,etc.
2- Unachievement or loss of Control levels
(glycaemic, BMI, lipids, B.P., etc)
3- Development or acceleration of complications.
Epidemiology :
*a current national study.
*Prevalence - Types and grades -- Risk factorsCorrelations with consequences
Types and Fields of uncompliance :
(simple or combinations)
I- In Medication:(insulin,oral & complementary)
- total stop ( of one or more medicines)
- diminish or exceed dose (or number of
injections).
- change type (e.g. mixed insulin instead
of NPH)
- interrupted treatment.
II- In Dieting
- unrestricted (exceed total intake)
- errors in caloric distribution , number of meals
snacks, skip meals, irregular timing ,etc.
- Type: Over- intake of Fat , Sugar, etc (salt)
III- In Exercise:
basal – working – sports .
IV- In Other Behaviours:
( smoking--alcohol –drugs addictions-contraindicated medications (eg. Steroids ).
Grades of Uncompliance :
- Minor and major
- Continuous or interrupted
- Single or multiple aspects
Diagnostic Approach to Uncompliance
A- Patient Factors :
1- Psychological state after recent discovery of diabetes
( at stages of denial , revolt , despair ….)
2- Having wrong concepts and belief ( health locus , cause of
illness , distorted information about diabetes.)
3- Nonspecific totalitarian lovers of opposing stand.
4- Slaves of their habits ( e.g. smoking , diet, exercise )
5- Transient depression from failing to achieve goals .
6- Transient stress : social , economic , inter-current illness.
B- Inadequate Education at Management
I- unclear objectives
Knowledge :,unsuitable to type and stage of diabetes ,wrong priorities.
Skills : psychomotor , communication and cognitive .
Attitudes and Behaviors.
II- Inadequate methods :
(a) In providing knowledge :
- Too much , or unsuitable content in a presentation.
- Poor performance at the one-to-one education ( listen,
motivate, encourage, etc. ).
- In small group education: ( ignorance of group dynamics )
- In large group presentation: ( Inability to ensure active
participation of audience.)
- In mass media education: (inducing panic and confusion).
- Inadequate use of AV- aids ,and education facilities .
( b)
In teaching skills,
inadequate description--demonstration and exercise .
(c) Neglect of attitudes changes
through model inspiration (good & bad) , contacts ,
discussions. etc.
III- Absence of follow-up evaluation:
- pre and post testing
- follow up records of control parameters and compliance
- check lists of performance of skills
- rating scales for attitude changes