- Email: [email protected]
Contracting with patients to improve compliance
91
SELECTED ABSTRACTS COMPLIANCE WITIt THERAPEUTIC
REGIMENS 1) Adherence to medication regimens in older adults: A function of the nurse-client relationship? UTZ, S. W. Univ. Mich. Sch. Nursing, Ann Arbor, Mich., U.S.A. Abstr. Hosp. Manage. Stud. 14(2), 18088 PA: 46 p., 1977 This study explored whether or not older ambulatory clients perceived the clinical nurse as influential in adherence or nonadherence to a nurse-taught medication regimen. Three hypotheses were tested: (a) subjects who perceived their interaction with the nurse as positive would more frequently be classified as adherers, (b) subjects who believed nurses should teach about medications would more frequently be classified as adherers; (c) subjects who demonstrated a greater knowledge of the newly prescribed medication would more frequently be classified as adherers. Ten subjects, aged 60 to 89 years, from three clinical settings were interviewed in the clinic and one month later in their homes. The first interview measured perceptions of the nurse-client interaction in the clinic, beliefs about the nurse's role, and knowledge of the newly prescribed medication. The second interview measured adherence to the prescribed medication regimen and other variables identified in the literature as possibly relevant to adherence behaviors. There was support for the hypothesis that clients who believe that nurses should teach about medications are more likely to adhere to the medication regimen. The other two hypotheses were not supported. However, there were several other findings of clinical significance to nurses. Nine clinical settings were contacted regarding possible participation in the study. In only three it was reported that nurses talked with clients about medications. In those three settings, only 12% had any change in their medication regimens during the course of the study. It was also noted that there were frequent discrepancies between the current medications listed in the medical records and those reported by the subjects. Ninety percent of the subjects reported that they took their medications on the basis of written instruc-
PALL/1978
tion on the label, rather than verbal instructions from the clinical nurse. 2) Contracting with patients to improve compliance STECKEL, S. B. and SWAIN, M. A. Univ. Mich. Sch. Nursing, Ann Arbor, Mich., U.S.A. Hospitals 51(23), 81-84, 1977 The systematic recognition and rewarding of healthrelated behaviors performed by patients are not generally found in today's health-care delivery system. As this research demonstrated, the principles of positive reinforcement can be effectively applied to a group of randomly selected outpatients. The statistically significant reduction in blood pressures and weight, the statistically significant increase in posttest scores, and the continuation of routine clinical care by the contract group attest to the effectiveness of providing reinforcement through contingency contracting. PREVENTION AND EARLY DETECTION
3) Preventive medicine education in family practice residency TREAT, D. F. Dept. Commun. Med., Univ. Rochester Sch. Med. Dent., Rochester, N.Y., U.S.A. Fogarty Int. Cent. Ser. Teach. Prey. Med. 5, 43-69, 1976 Preventive medicine and the primary-care disciplines can and should be closely linked. Each has a great deal to offer the other. Preventive medicine, which tends to concern itself with health problems arising from the environment and communal living, needs better access to data about the health problems of individuals and families. Primary-care physicians, on the other hand, need a more comprehensive understanding of the communities in which their patients live. If preventive medicine also provides the primarycare physician with portable useful tools in epidemiology, biostatistics, and operations research, cooperative and joint efforts in many important areas of healthcare research should be one significant result. Equally important should be the professional satisfactions accruing to the practicing physician and the health benefits provided to the patients.
SELECTED ABSTRACTS COMPLIANCE WITIt THERAPEUTIC
REGIMENS 1) Adherence to medication regimens in older adults: A function of the nurse-client relationship? UTZ, S. W. Univ. Mich. Sch. Nursing, Ann Arbor, Mich., U.S.A. Abstr. Hosp. Manage. Stud. 14(2), 18088 PA: 46 p., 1977 This study explored whether or not older ambulatory clients perceived the clinical nurse as influential in adherence or nonadherence to a nurse-taught medication regimen. Three hypotheses were tested: (a) subjects who perceived their interaction with the nurse as positive would more frequently be classified as adherers, (b) subjects who believed nurses should teach about medications would more frequently be classified as adherers; (c) subjects who demonstrated a greater knowledge of the newly prescribed medication would more frequently be classified as adherers. Ten subjects, aged 60 to 89 years, from three clinical settings were interviewed in the clinic and one month later in their homes. The first interview measured perceptions of the nurse-client interaction in the clinic, beliefs about the nurse's role, and knowledge of the newly prescribed medication. The second interview measured adherence to the prescribed medication regimen and other variables identified in the literature as possibly relevant to adherence behaviors. There was support for the hypothesis that clients who believe that nurses should teach about medications are more likely to adhere to the medication regimen. The other two hypotheses were not supported. However, there were several other findings of clinical significance to nurses. Nine clinical settings were contacted regarding possible participation in the study. In only three it was reported that nurses talked with clients about medications. In those three settings, only 12% had any change in their medication regimens during the course of the study. It was also noted that there were frequent discrepancies between the current medications listed in the medical records and those reported by the subjects. Ninety percent of the subjects reported that they took their medications on the basis of written instruc-
PALL/1978
tion on the label, rather than verbal instructions from the clinical nurse. 2) Contracting with patients to improve compliance STECKEL, S. B. and SWAIN, M. A. Univ. Mich. Sch. Nursing, Ann Arbor, Mich., U.S.A. Hospitals 51(23), 81-84, 1977 The systematic recognition and rewarding of healthrelated behaviors performed by patients are not generally found in today's health-care delivery system. As this research demonstrated, the principles of positive reinforcement can be effectively applied to a group of randomly selected outpatients. The statistically significant reduction in blood pressures and weight, the statistically significant increase in posttest scores, and the continuation of routine clinical care by the contract group attest to the effectiveness of providing reinforcement through contingency contracting. PREVENTION AND EARLY DETECTION
3) Preventive medicine education in family practice residency TREAT, D. F. Dept. Commun. Med., Univ. Rochester Sch. Med. Dent., Rochester, N.Y., U.S.A. Fogarty Int. Cent. Ser. Teach. Prey. Med. 5, 43-69, 1976 Preventive medicine and the primary-care disciplines can and should be closely linked. Each has a great deal to offer the other. Preventive medicine, which tends to concern itself with health problems arising from the environment and communal living, needs better access to data about the health problems of individuals and families. Primary-care physicians, on the other hand, need a more comprehensive understanding of the communities in which their patients live. If preventive medicine also provides the primarycare physician with portable useful tools in epidemiology, biostatistics, and operations research, cooperative and joint efforts in many important areas of healthcare research should be one significant result. Equally important should be the professional satisfactions accruing to the practicing physician and the health benefits provided to the patients.