Chronic Illness and Disability

Introduction to Patients with Multiple Chronic Diseases

Patients with multiple chronic diseases are living a complicated life and the quality of their life is poor (Blaum et al., 2018). Patients with multiple chronic diseases have a stringent medication regime to overcome the concurrent chronic conditions. The multiple chronic conditions require an interdisciplinary team that facilitates expert care for the patients and prescribe the medication regime (Ploeg et al., 2017). Medication adherence is one of the very important factor in the management of multiple chronic diseases because it is directly associated with positive patient outcomes and is also related to improving the quality of life of these patients. There are different types of patients like some adhere to the medication regime whereas others do not. This creates a lot of difficulty for the health care professionals in managing the chronic diseases among the patients who are poor at adhering to the medication regime.

Consequences of Medication Non-Adherence for Patients with Multiple Chronic Diseases

The medication non- adherence is quite common in patients with multiple chronic diseases and this is contributed by multiple reasons (Yap et al., 2016). The consequences are always known in such cases as there is a threshold effect to medication noncompliance (Brown et al., 2016). The effects that are the consequences of the non- adherence to the medication regime are always manifested in the clinical outcomes of the patient. The severe consequences of the non- adherence to medicines include risk of re-hospitalization, higher cost of treatment, development of the complications and other consequences that the patient will never get ready to accept (Abegaz et al., 2017). Other consequences include worsening condition and the most severe consequence that may occur is death.

The Patient Factors Likely to Affect Medication Adherence

The non- adherence to the medication regime is largely contributed by the patients and a very small proportion of this error may be contributed by the medical health care professionals (McQuaid, 2018). The patient-related factors that are likely to affect the medication adherence are physical and mental function, having lower medication regime education, age-related factor and so on. Therapeutic compliance is very low due to the cost of the medicines, physical difficulties, forgetfulness, no desire to live life and low health literacy. There are some of the social and economic factors like cost and income of the health care routine that includes the non- affordable prices of the medicines, inability to take time off the week and rarely the factor if difficulty in getting the prescriptions filled (Polonsky & Henry, 2016). The age-related factors like old age and forgetfulness also significantly contribute to non- adherence to the medication regime.

Some of the patients are known to not adhere to the medication regime because they think that the medicines are not working for their betterment therefore they stop taking them (Gonzalez et al., 2016). Some of the adolescents do not take medicines in front of their peers due to stigmatization and especially not infront of the people who do not have to manage their health conditions.

Some of the other reasons for the non- adherence to the medication regime are erroneous belief about the treatment plan and also the belief that this disease is uncontrollable (Napolitano et al., 2016).

Three Suitable Strategies to Overcome Patient-Initiated Barriers to Improve Medication Adherence for Patients with Multiple Chronic Diseases

The Registered Nurse (RN) is one amongst the health care professionals and the member of the multidisciplinary team that plays an important role in managing the multiple chronic diseases in the patients. They have an important part in making the patients adhere to the medication regime because they apply interventions to overcome the patient-initiated barriers that help in improving the medication regime for patients with multiple chronic diseases.

1. By addressing the mental barriers and stigma:

The nurse must address the mental barriers in the patients such as the fear of dependence, fear of stigma and the fear among adolescents that their friends will make fun of them (Herrera, Moncada&Defey, 2017). These are the main personal barriers that resist patients from adhering to their medication regime. The nurses must conduct motivational interviews and some coaching sessions in which there would be one on one interviews to address such mental/personal barriers that interfere with adherence to medication regime (Behel&Rybarczyk, 2019).

2. By setting up reminders for the patients in the organisational systems and scheduling appointments:

The patients who lead hectic lives and the old age patients are generally at more risk of not adhering to their medication regime due to forgetfulness (Mickelson & Holden, 2018). The nurses can set reminders for them as health IT professionals present with numerous opportunities like there is a chronic care self- management app that the nurse can use to set reminders for such people. The smartphone apps can also be used to set reminders and for the people with low socio-economic status, various appointments can be scheduled like after every five days wherein they are strictly instructed to adhere to the medication regime and after five days they are evaluated and again reminded to do so (Kao &Liebovitz, 2017). This will develop a consistent medication management routine in these low socio-economic people without the use of technology. The patients can also be encouraged to adhere to their medication regime as if they are supposed to take their medicine after breakfast then they can keep the box of medicine on their breakfast table.

3. By establishing a nurturing relationship with the patients and educate them:

The educational component is very important for the RN to use for educating the patients on adhering to the medication regime because this is a very helpful technique (Alleman, 2017). The nurses must establish a therapeutic relationship with the patients and must educate them on the correct doses, route of administration and the importance of medicines. This will overcome their fear of incorrect doses, dependency on the medicines, their belief that this medicine is not working for me and their non- belief in medicines because they think that these chronic diseases are uncontrollable (Benson et al., 2017).

The Registered Nurse Evaluation on The Efficacy of These Techniques

The RN can evaluate these techniques by scheduling an appointment with the patients and asking them for feedback for each technique (Khan & Ahmad, 2019). The monitoring of the condition of the patient is also an evaluation technique for the above-mentioned methods.

References for Chronic Illness and Disability

Abegaz, T. M., Shehab, A., Gebreyohannes, E. A., Bhagavathula, A. S., &Elnour, A. A. (2017). Nonadherence to antihypertensive drugs: A systematic review and meta-analysis. Medicine, 96(4).

Allemann, S. S., Nieuwlaat, R., Navarro, T., Haynes, B., Hersberger, K. E., &Arnet, I. (2017). Congruence between patient characteristics and interventions may partly explain medication adherence intervention effectiveness: An analysis of 190 randomized controlled trials from a Cochrane systematic review. Journal of Clinical Epidemiology, 91, 70-79.

Behel, J. M., &Rybarczyk, B. (2019). Interviewing in health psychology and medical settings. In Diagnostic Interviewing(pp. 481-503). Springer, New York, NY.

Benson, E. O. N., Okeke, N. T., & Okeke, C. B. (2017). factors that influence insulin adherence in self-administration and actions that could improve it. J Nursing Palliatserv 1: 106. Journal of Nursing Palliative services, 1(1), 16-22.

Blaum, C. S., Rosen, J., Naik, A. D., Smith, C. D., Dindo, L., Vo, L., ... & Costello, D. (2018). Feasibility of implementing patient priorities care for older adults with multiple chronic conditions. Journal of the American Geriatrics Society, 66(10), 2009-2016.

Brown, M. T., Bussell, J., Dutta, S., Davis, K., Strong, S., & Mathew, S. (2016). Medication adherence: Truth and consequences. The American Journal of the Medical Sciences, 351(4), 387-399.

Gonzalez, J. S., Tanenbaum, M. L., & Commissariat, P. V. (2016). Psychosocial factors in medication adherence and diabetes self-management: Implications for research and practice. American Psychologist, 71(7), 539.

Herrera, P. A., Moncada, L., &Defey, D. (2017). Understanding non-adherence from the inside: hypertensive patients’ motivations for adhering and not adhering. Qualitative Health Research, 27(7), 1023-1034.

Kao, C. K., &Liebovitz, D. M. (2017). Consumer mobile health apps: Current state, barriers, and future directions. PM&R, 9(5), S106-S115.

Khan, M., & Ahmad, A. (2019). The efficacy of health and healthcare m-health techniques: Protocol for systemic review. Available at SSRN 3478749.

McQuaid, E. L. (2018). Barriers to medication adherence in asthma: The importance of culture and context. Annals of Allergy, Asthma & Immunology, 121(1), 37-42.

Mickelson, R. S., & Holden, R. J. (2018). Medication adherence: Staying within the boundaries of safety. Ergonomics, 61(1), 82-103.

Napolitano, F., Napolitano, P., Angelillo, I. F., & Collaborative Working Group. (2016). Medication adherence among patients with chronic conditions in Italy. The European Journal of Public Health, 26(1), 48-52.

Ploeg, J., Matthew-Maich, N., Fraser, K., Dufour, S., McAiney, C., Kaasalainen, S., & Emili, A. (2017). Managing multiple chronic conditions in the community: A Canadian qualitative study of the experiences of older adults, family caregivers and healthcare providers. BMC Geriatrics, 17(1), 40.

Polonsky, W. H., & Henry, R. R. (2016). Poor medication adherence in type 2 diabetes: Recognizing the scope of the problem and its key contributors. Patient Preference and Adherence, 10, 1299.

Yap, A. F., Thirumoorthy, T., & Kwan, Y. H. (2016). Medication adherence in the elderly. Journal of Clinical Gerontology and Geriatrics, 7(2), 64-67

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