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The nurse and patient self-care
35 Treatment adherence in hypertension 13LACKWELL, B. Department of Psychiatry, School of Medicine, Wright State University, Dayton, Ohio, U.S.A. Hypertension is the commonest chronic disease. Despite the high morbidity and mortality and the established benefits of treatment a majority of patients show low adherence manifested by reluctance either to enter or to remain in treatment. Attempts to define features associated with poor adherence have dealt mainly with superficial or unalterable characteristics and have failed to reveal a stable stereotype. Previous attempts to improve adherence have focused on educational and supervisory strategies, the effects of which having been counter-productive or poorly sustained. Future efforts at understanding are expected to focus more on health beliefs and illness behavior models. Methods to improve adherence are predicted that will make use of psychological strategies derived from these models. A place will remain for use of mechanical devices in some individuals, and the beneficial effects of such a device are briefly reported.
A national high blood-pressure education research program McGILL, A. M. Prevention Control and Education Program, Division of Heart and Cardiovascular Diseases, National Heart and Lung Institute, National Institutes of Health, Bethesda, Md., U.S.A. In 1972 the Secretary of Health Education and Welfare established the national high blood-pressure education program. The program goal is nationwide improvement in the control of hypertension through educational efforts directed at the public, patients, and health care providers. A central issue in the control of hypertension is how to best assist the patient to maintain the required lifelong therapy. Thus, education research is an integral part of our national high blood-pressure education program. The initial research goals focused on determining the most effective educational methods to increase public and health-care provider awareness of hypertension. Recognizing, however, that individual factors often influence compliance with therapy our research goals in our later studies focused on tailoring educational methods to the psychosocial characteristics of the hypertensive patient. The eleven projects in our program focus on a broad spectrum of educational and behavioral intervention, in order to enhance compliance behavior anaong hypertensive patients from a variety of socio-economie backgrounds in different kinds of health care setting.
The nurse and patient self-care NEGRETE, V. F. Children's Hospital of Los Angeles, 4650 Sunset Boulevard, Los Angeles, Calif., U.S.A. The nurse working in an extended role has a vital part to play in fostering self-care and compliance with medical
~RST QUARTER/1978
advice for patients with chronic illness. Compliance studies have shown that the cultural and demographic background of the patient, the severity of the illness, and the type of medical regimen that is prescribed affect compliance with physicians' advice. Since physicians' prescriptions and the technologic aspects of treatment are based on the specific diagnosis find tend to be the same for all patients, the nurse needs to increase the professional team's awareness of the differences among patients, and their responses and adaptation to illness, so that care can be individualized. Also, our own work and that of others has shown that the nature of the communication between health professionals and patients and their relationship influences follow-through on medical advice. Here the traditional patient-centered approach of the nurse and her continuing relationship with the patient and family can make a unique contribution. In addition, the nurse through her support can enhance the patients' competence and improve their self-concept. This in turn will help patients realize and accept the relationship between their health behavior and their well being. The end result for the patients will be improved health with increased responsibility for and participation in their own care.
The frequency and determinants of compliance NEUTRA, R. Department of Social and Preventive Medicine, Harvard Medical School, Boston, Mass., U.S.A. Compliance is defined as the degree to which a patient's behavior matches the behavior which the physician recommends. The behavior usually relates to medication, diet, exercise, or a schedule of appointments. There is need for research into the relationship between degree of compliance and therapeutic success, although there is experimental evidence in certain diseases that increased patient compliance can reduce morbidity and hospital costs. With the exception of appointment keeping, it is nearly impossible to directly measure patient compliance behavior. Surrogate measures ranging from patient selfreporting to the measurement of serum or urine drug levels have been tried. Patients are consistently found to over-report their own compliance. The proportion of patients whowill take a full course of curative medication as prescribed has been estimated to be only 50%. Some variables cart only be used to predict noncompliance and are not themselves susceptible to change. Examples are extreme age and poverty, unpleasant previous experience with the regimen or the disease, and nonsupportive family members. Previous noncompliance with a similar regimen is another strong predictor. Studies have shown correlations between compliance and variables which can in principle be manipulated to improve compliance. These include the simplicity of the regim.en, the clarity and closeness of supervision, the acceptability of personnel and clinic organization, continuity of care, quality of patient-provider interaction, and the patient's belief about therapy and his vulnerability to the disease. Knowledge about the disease makes no difference in
A national high blood-pressure education research program McGILL, A. M. Prevention Control and Education Program, Division of Heart and Cardiovascular Diseases, National Heart and Lung Institute, National Institutes of Health, Bethesda, Md., U.S.A. In 1972 the Secretary of Health Education and Welfare established the national high blood-pressure education program. The program goal is nationwide improvement in the control of hypertension through educational efforts directed at the public, patients, and health care providers. A central issue in the control of hypertension is how to best assist the patient to maintain the required lifelong therapy. Thus, education research is an integral part of our national high blood-pressure education program. The initial research goals focused on determining the most effective educational methods to increase public and health-care provider awareness of hypertension. Recognizing, however, that individual factors often influence compliance with therapy our research goals in our later studies focused on tailoring educational methods to the psychosocial characteristics of the hypertensive patient. The eleven projects in our program focus on a broad spectrum of educational and behavioral intervention, in order to enhance compliance behavior anaong hypertensive patients from a variety of socio-economie backgrounds in different kinds of health care setting.
The nurse and patient self-care NEGRETE, V. F. Children's Hospital of Los Angeles, 4650 Sunset Boulevard, Los Angeles, Calif., U.S.A. The nurse working in an extended role has a vital part to play in fostering self-care and compliance with medical
~RST QUARTER/1978
advice for patients with chronic illness. Compliance studies have shown that the cultural and demographic background of the patient, the severity of the illness, and the type of medical regimen that is prescribed affect compliance with physicians' advice. Since physicians' prescriptions and the technologic aspects of treatment are based on the specific diagnosis find tend to be the same for all patients, the nurse needs to increase the professional team's awareness of the differences among patients, and their responses and adaptation to illness, so that care can be individualized. Also, our own work and that of others has shown that the nature of the communication between health professionals and patients and their relationship influences follow-through on medical advice. Here the traditional patient-centered approach of the nurse and her continuing relationship with the patient and family can make a unique contribution. In addition, the nurse through her support can enhance the patients' competence and improve their self-concept. This in turn will help patients realize and accept the relationship between their health behavior and their well being. The end result for the patients will be improved health with increased responsibility for and participation in their own care.
The frequency and determinants of compliance NEUTRA, R. Department of Social and Preventive Medicine, Harvard Medical School, Boston, Mass., U.S.A. Compliance is defined as the degree to which a patient's behavior matches the behavior which the physician recommends. The behavior usually relates to medication, diet, exercise, or a schedule of appointments. There is need for research into the relationship between degree of compliance and therapeutic success, although there is experimental evidence in certain diseases that increased patient compliance can reduce morbidity and hospital costs. With the exception of appointment keeping, it is nearly impossible to directly measure patient compliance behavior. Surrogate measures ranging from patient selfreporting to the measurement of serum or urine drug levels have been tried. Patients are consistently found to over-report their own compliance. The proportion of patients whowill take a full course of curative medication as prescribed has been estimated to be only 50%. Some variables cart only be used to predict noncompliance and are not themselves susceptible to change. Examples are extreme age and poverty, unpleasant previous experience with the regimen or the disease, and nonsupportive family members. Previous noncompliance with a similar regimen is another strong predictor. Studies have shown correlations between compliance and variables which can in principle be manipulated to improve compliance. These include the simplicity of the regim.en, the clarity and closeness of supervision, the acceptability of personnel and clinic organization, continuity of care, quality of patient-provider interaction, and the patient's belief about therapy and his vulnerability to the disease. Knowledge about the disease makes no difference in