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Factors Impacting On Patient Compliance with Medical Advice: Empirical Study

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Abstract

The purpose of this paper to identify factors which have a bearing on compliance with medical advice in various age groups. The survey was conducted, using the CAWI method, on a representative sample of 1000 respondents who declared having used healthcare services in the previous six months. Control of competences is one of the strongest factors which is common for the oldest and youngest groups. Interestingly, trust in the integrity and honesty of doctors is significant for the youngest patients, i.e., the higher is the level of trust, the lower is the tendency to non-comply. Another type of trust is related to the benevolence of doctors and is significant to patients of the middle age group. Satisfaction is a significant predictor in the two oldest groups of patients. High levels of satisfaction seem to deter people from non-adherence to recommended treatment regimens. The results of the present study provide knowledge about the nature and diversity of factors behind patient compliance in various age groups.
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... The patient may need to take medications accurately, adhere to a diet, restrict their activities, promoting rest, and seeks periodic evaluation of their health status. The role of the nurse in teaching and directing patient towards adherence is a significant one (Krot and Sousa, 2017) [27] . Patient's compliance consists a complex and multidimensional health issue. ...
... The patient may need to take medications accurately, adhere to a diet, restrict their activities, promoting rest, and seeks periodic evaluation of their health status. The role of the nurse in teaching and directing patient towards adherence is a significant one (Krot and Sousa, 2017) [27] . Patient's compliance consists a complex and multidimensional health issue. ...
... Furthermore, all patients who did not have HE recurrence were adherent to their treatment. Likewise Krot and Sousa, (2017) [27] support these results as they stated that the increase in the degree patient compliance with medical recommendations brings considerable clinical and economic benefits for both patients and entire healthcare systems. www.nursingjournal.net ...
... Regarding gender, our research shows that women have higher adherence to their PCPs' instructions. This is consistent with most research findings (7,8,19,40) and may be because women's body resistance is relatively weak, such that they are keener on practicing self-care. Patients with good self-rated health have higher treatment adherence and tend to be more energetic and motivated to maintain this status quo (12,41). ...
... This difference may be attributed to the research object. Our research subjects were mostly older patients from rural China, and because of educational, social, and environmental factors, their self-care awareness was poor, which may have led to excessive dependence on doctors, i.e., they believe that the treatment plan chosen by their physician is best for them and that the physician is competent enough to resolve their disease (8,23,40,45). As such, these patients were not too concerned about the consequences of Non-adherence behaviors (23,40,45), which in turn may lead them to engage in more Non-adherence behaviors. ...
... Our research subjects were mostly older patients from rural China, and because of educational, social, and environmental factors, their self-care awareness was poor, which may have led to excessive dependence on doctors, i.e., they believe that the treatment plan chosen by their physician is best for them and that the physician is competent enough to resolve their disease (8,23,40,45). As such, these patients were not too concerned about the consequences of Non-adherence behaviors (23,40,45), which in turn may lead them to engage in more Non-adherence behaviors. This speculation is supported by a study by Lu et al. (41), who found that the probability of treatment adherence increased by five times for patients with greater concerns about health consequences. ...
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In rural China, treatment adherence of patients with hypertension remains a challenge. Although early research on patient adherence has confirmed the importance of trust in doctors, the relative contribution and influence of the two-dimensional structure of trust on adherence has not been explored. Thus, this study examined the effects of patient trust in primary care physicians' (PCPs) benevolence and ability on medication adherence, dietary management, and physical activity. The data were derived from 2,533 patients at 54 primary health institutions in China (village level) from February 2017 to May 2018. Participants were assessed using the Chinese version of the Wake Forest Physician Trust Scale and the Therapeutic Adherence Subscale for Hypertensive Patients. Other information included region, gender, age, and self-rated health status. The results of multiple linear regression and structural equation modeling confirmed that patient trust in PCPs' benevolence was positively correlated with patient adherence to medication, diet management, and physical activity. Patient trust in PCPs' ability was negatively correlated with adherence to dietary management and physical activity. We concluded that interventions aimed at increasing PCP benevolence have the greatest potential to improve patient adherence to hypertension treatment. Under the country's policy of advocating to improve PCPs' diagnoses and treatment technology, it may be important to cultivate doctors' communication skills, medical ethics, and other benevolent qualities to improve patients' adherence with drug and Non-drug treatments.
... This optimism is relevant since the quality of the patient-physician relationship can influence patient compliance with medical advice. 25 On the other hand, our findings suggest that healthcare providers seem to be neutral regarding the utility of RPM in ensuring patient treatment adherence. Historically, patients' adherence to physicians' recommendations has been a challenge that healthcare systems have encountered even in traditional face-to-face encounters, 26 which may explain healthcare providers' expectation to encounter similar issues with remote patient care. ...
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Remote patient monitoring (RPM) technologies have been identified as a viable alternative to improve access to care in underserved communities. Successful RPM platforms are designed and implemented for seamless integration into healthcare providers work to increase adoption and availability for offering remote care. A quantitative survey was designed and administered to elicit perspectives from a wide range of stakeholders, including healthcare providers and healthcare administrators, about barriers and facilitators in the adoption and integration of RPM into clinical workflows in underserved areas. Ease of adoption, workflow disruption, changes in the patient-physician relationship, and costs and financial benefits are identified as relevant factors that influence the widespread use of RPM by healthcare providers; significant communication and other implementation preferences also emerged. Further research is needed to identify methods to address such concerns and use information collected in this study to develop protocols for RPM integration into clinical workflow.
... Trust has been proven to be an important factor in determining how often users interact with systems providing healthcare services [35], which influences their acceptance of health information [25], adherence to medical advice and medication [20], and satisfaction with the system [9]. While trust towards the technology has mainly been assessed using surveys [24,29], interviews have also been used to evaluate how and why users trust the system [11]. ...
Conference Paper
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Recently, chatbots have been deployed in health care in various ways such as providing educational information, and monitoring and triaging symptoms. However, they can be ineffective when they are designed without a careful consideration of the cultural context of the users, especially for marginalized groups. Chatbots designed without cultural understanding may result in loss of trust and disengagement of the user. In this paper, through an interview study, we attempt to understand how chatbots can be better designed for Black American communities within the context of COVID-19. Along with the interviews, we performed design activities with 18 Black Americans that allowed them to envision and design their own chatbot to address their needs and challenges during the pandemic. We report our findings on our participants’ needs for chatbots’ roles and features, and their challenges in using chatbots. We then present design implications for future chatbot design for the Black American population.
... al 15 found that more women complied with sexual abstinence advice for up to 3 months after treatment compared with men and this is consistent with studies on compliance to other types of medical advice in which women are more likely to adhere to treatment recommendations, although the absolute difference was small. 16 However, our cohort was mainly male (82%) and it is likely that we did not have sufficient power to identify gender-specific associations. Those of Black ethnicity were found to be more sexually abstinent compared with Caucasians when assessed 3 months after treatment for bacterial STIs in the USA. ...
Article
Objectives We explored sexual contact in the interval between the treatment for gonorrhoea and attending for a test of cure (ToC) and identified factors associated with sexual contact in this period. Methods Multivariable analysis of demographic, behavioural and clinical data with self-reported sexual contact prior to attending for a gonorrhoea ToC evaluation among participants recruited into the ‘Gentamicin for the Treatment of Gonorrhoea’ trial in England, between October 2014 and November 2016. Associations with sexual contact were expressed as prevalence ratios (PR) and their corresponding 95% CI. Results The median time to ToC was 15 days (interquartile range 14–20 days). 197/540 (37%) participants reported sexual contact in the time between treatment and ToC. Of these, 173/197 (88%) participants reported inconsistent condom use, including with previous partners (133/197 (68%)). A history of gonorrhoea (adjusted PR (aPR) 1.32 (1.03 to 1.69)) or syphilis (aPR 1.19 (1.08 to 1.32)), being in regular (aPR 1.71 (1.41 to 2.09)) sexual relationships, high number of partners in the last 3 months (aPR 1.77 (1.25 to 2.51))—‘more than 5 partners’ vs ‘0 to 1 partner’, and attending for a ToC more than 14 days after treatment (aPR 1.40 (1.08 to 1. 81)) were associated with reporting sexual contact before the ToC appointment. However, age (aPR (1.00 (0.99 to 1.01)) and presenting with specific symptoms at baseline (aPR 1.17 (0.95 to 1.44)) were not associated with sexual contact by the ToC attendance. Conclusion Sexual activity after receiving treatment for gonorrhoea and prior to a ToC evaluation was common. This was associated with previous infection history and specific behavioural characteristics. Knowledge of these factors can help guide safe sex counselling at the time of treatment.
... 6,20,21,27,28 It can be inferred that the COPD re-admission rate will be higher in men, as men have a higher prevalence of COPD, because a larger proportion of men are smokers and their compliance with medical recommendations is less than that of women. 29 Additionally, although the mechanism remains incompletely understood, factors associated with this include the susceptibility to toxin inhalation, airway structures, and female sex hormones. 30,31 A longer hospitalization period also implies that the disease was more severe and difficult to treat; consequently, the COPD re-admission rate is likely to be higher. ...
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Purpose: Up to 20% of patients with chronic obstructive pulmonary disease (COPD) require re-admission within 30 days of discharge after hospitalization for acute exacerbations of the disease. These re-admissions can increase morbidity and the economic burden of COPD. Reducing re-admissions has become a policy target in many developed countries. We investigated the risk factors for COPD re-admissions among older adults with COPD. Patients and methods: Data obtained from the National Health Insurance Service-Senior Cohort (NHIS-SC) in Korea were analyzed. The subjects included 558,147 patients aged ≥70 who had been admitted for COPD between 2013 and 2015. Re-admission was defined as being re-hospitalized within 30 days after discharge. The key variables selected from the database included income-based insurance contributions, demographical variables, information on inpatient medical services, types of healthcare facilities, and emergency time relevance index (TRI). The TRI is a regional medical-use analysis index that evaluates whether the capacity of the medical services available is appropriate for the medical needs of the target residents. Results: In 814 COPD re-admission cases among 4867 total admissions due to COPD in elderly subjects, higher re-admission rates were associated with male sex, admission to district hospitals, medical aid recipients, and a longer hospital stay. When additionally adjusting the TRI to identify the difference in re-admission rates due to medical service accessibility, the same results were found, except for the areas of residence. The TRI was lower in re-admission cases (odds ratio 0.991 [95% CI, 0.984‒0.998], P = 0.013). Conclusion: In this study, COPD re-admission rates among older adults were significantly associated with sex, length of hospital stay, and the type of hospital. The capacity of the medical services provided was also related to the COPD re-admission rate. Better access to appropriate emergency services is associated with reduction of COPD re-admission rates.
... It can be assumed that higher trust levels are typically associated with positive behaviors. In the health care context, it may be assumed that public trust creates a higher level of patient satisfaction and leads to better compliance with medical treatment, which in turn ultimately influences the level of consumption of health-care services [67]. On the other hand, a lack of trust (mistrust) entails poor clinical relationships that exhibit less continuity, poorer adherence to the doctors' recommendations, and a reduced degree of patient-physician interaction [66]. ...
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Overconsumption of health care is an ever-present and complex problem in health systems. It is especially significant in countries in transition that assign relatively small budgets to health care. In these circumstances, trust in the health system and its institutions is of utmost importance. Many researchers have studied interpersonal trust. Relatively less attention, however, has been paid to public trust in health systems and its impact on overconsumption. Therefore, this paper seeks to identify and examine the link between public trust and the moral hazard experienced by the patient with regard to health care consumption. Moreover, it explores the mediating role of patient satisfaction and patient non-adherence. For these purposes, quantitative research was conducted based on a representative sample of patients in Poland. Interesting findings were made on the issues examined. Patients were shown not to overconsume health care if they trusted the system and were satisfied with their doctor-patient relationship. On the other hand, nonadherence to medical recommendations was shown to increase overuse of medical services. The present study contributes to the existing knowledge by identifying phenomena on the macro (public trust in health care) and micro (patient satisfaction and non-adherence) scales that modify patient behavior with regard to health care consumption. Our results also provide valuable knowledge for health system policymakers. They can be of benefit in developing communication plans at different levels of local government.
... Dissatisfaction with healthcare is associated with noncompliance of the treatment regimen and discontinuation of care (Krot & Sousa 2017;Rama & Kanagaluru 2011). Nonadherence, a characteristic of poor patient self-management, can increase mortality and disability, as well as healthcare costs (Currie et al. 2013). ...
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Background: Measuring client satisfaction is part of the quality assurance process and has become an integral part of healthcare management strategies globally. It is essential for improvement of amenities in healthcare facilities. Objectives: The aim of this study was to assess patients with type 2 diabetes’ satisfaction with healthcare services at primary healthcare settings in the Cape Metropolitan district, Western Cape, South Africa. Methods: This cross-sectional study used proportionate stratified random sampling. The Patient Survey for Quality of Care scale was used to assess patients with type 2 diabetes’ satisfaction with quality of care received. Descriptive and inferential statistics were employed in the analysis of the quantitative data. The open-ended question was analysed qualitatively. Results: The majority of patients were satisfied with the overall quality of care. Dissatisfaction was reported for waiting time to get appointments at the clinic, to see a healthcare professional on the same day and clarity of instructions for managing their diabetes. Conclusion: Employing more staff in the multidisciplinary team and improving health information by developing staff through continuous education could foster more positive experiences and provide care that contributes to the well-being of patients. Clinical implications: Addressing patients’ views regarding quality of healthcare services could assist in overall improvement of healthcare provision through the rectification of the system weaknesses. Satisfaction with quality of care could positively affect adherence to treatment protocols that could lead to better quality of life of patients with type 2 diabetes.
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This study qualitatively examined how nurses, nurse practitioners, and nurse midwives construct the meaning of patient trust in their work caring for pregnant and laboring women. Twenty-two interviews were conducted with nurse participants employed at clinics, hospitals, and birth centers across Southeastern United States. Using a normative theoretical approach within the multiple goals framework, we identified five emergent themes that characterize trust as it shapes nurses’ communicative goals: trust as the woman’s acceptance of vulnerability and risk, the woman relinquishing control, the woman conceding to the nurse’s expertise, the woman feeling heard, and the woman’s disclosure of information. The results support previous studies, which conceptualized trust as vulnerability, risk, and disclosure whereas the remaining themes are original to this study. The results are interpreted both in light of existing links between trust and communication and the shifting and conflicting goals of nurses as they attempt to achieve their primary goal of optimal health outcomes. Passive constructions of trust that conflate it with women’s acquiescent behaviors could have implications for the quality of communication between nurses and patients. In addition, trust, as understood by these participants, becomes situated as an instrumental means to achieving patient cooperation and desired health outcomes rather than a relational goal that supports women’s agency throughout obstetric and intrapartum processes. This may be at odds with the modern movement toward patient-centered care and shared decision-making in U.S. maternity care.
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The aim of the study is to compare the level of innovation of companies introducing innovations with consumer participation with that of other innovative providers of health tourism services. The following hypothesis was formulated: Companies benefiting from the participation of consumers in the process of innovation represent a higher level of innovativeness than other innovative providers of health tourism services. The following methods were used: a comparative analysis, a questionnaire (CAWI and PAPI), a standardized interview, and the ranking method. 461 providers of health tourism services participated in the research. The value and implications of the paper for the economic sciences contribute to the development of innovation theory. The hypothesis has been positively verified. The research shows a much higher level of innovation in companies cooperating with consumers (patients) than that of other respondents.
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Apart from the fact that trust between doctors and patients is a source of sustainable relations, affecting the behaviour of both parties, it also has its therapeutic value. Therefore, this paper aims to construct a model of trust in the doctor-patient relationship based on qualitative research (analysis of the contents of Internet message boards). The study has revealed that trust towards doctors is a result of overlapping and interpenetration of two levels of trust: macro- and meso-. Macro-trust can be seen as a context in which all the dimensions of institutional trust are ‘embedded’. Whereas meso-trust (institutional) is described in terms of three dimensions: benevolence, competence and integrity.
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Objectives: The concepts of patient empowerment, patient participation and patient-centeredness have been introduced as part of the trend towards a more participatory health care and have largely been used interchangeably. Although these concepts have been discussed for a number of years, their exact meaning in hospital care remains somewhat unclear. This absence of theoretical and conceptual clarity has led to (1) poor understanding and communication among researchers, health practitioners and policy makers and (2) problems in measurement and comparison between studies across different hospitals. Methods: This paper examines all three concepts through a concept analysis based on the method of Avant and Walker (2005) [1] and the simultaneous concept analysis of Haase et al. (1992) [2]. Results: Through these methods, the antecedents, attributes, consequences and empirical referents of each concept are determined. In addition, similarities and differences between the three concepts are identified and a definition offered for each concept. Furthermore, the interrelatedness between the key concepts is mapped, and definitions are proposed. Conclusions: It can be concluded that patient empowerment is a much broader concept than just patient participation and patient-centeredness. Practice implications: The present study may provide a useful framework that researchers, policy makers and health care providers can use to facilitate patient empowerment.
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Purpose – The purpose of this paper is to assess and examine the impact of physicians-nurses performance on patient perceptions on safety, trust and satisfaction. Design/methodology/approach – A cross-sectional study of 170 inpatients at 78 Chinese hospitals has been conducted. A structured questionnaire covering multiple constructs was used to collect the data. Methodology is described and results are discussed. Findings – Multivariate regression results show that despite the variations in education and training of physicians and nurses, trust is statistically significant in the models with doctors performance and nurses performance as dependent variables. One surprise result is that patient safety is not statistically significant in the regression model with NP as dependent variable. Practical implications – Doctor and nurses as well as other staff at any healthcare setting or ward should provide patients with high-quality and safe healthcare. Competences and performance of physicians and nurses are the primary source of patient safety. Social implications – The patient correlate their patients safety with doctors but not with nurses. On the other hand, they relate their satisfaction more to nurses performance than doctors performance.
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