1. 3.3 ADHERENCE TO MEDICAL ADVICE

2. Reasons for non adherence Key study: Bulpitt and Fletcher (1988) Aim  To review research on adherence in hypertensive patients. Method  Review article of research identifying problems with taking drugs for high blood pressure.

3. Procedure  Research was analysed to identify the physical and psychological effects of drug treatment and the adherence rates of patients.

4. Findings  There are many side effects of taking anti- hypertension medication.  In one study by Curb (1985) 8% of males discontinued treatment because of sexual problems.  Research by the Medical Research Council (1981) found that 15% of patients had withdrawn from taking medication due to side effects.

5. Conclusion  When the costs of taking medication, such as side effects, outweigh the benefits of treating a mainly asymptomatic problem such as hypertension, there is less likelihood of the patient adhering to their treatment.

6. Measuring adherence Key study: Lustman et al. (2000) Aim  To assess the efficacy of the anti-depressant fluoxetine in treating depression by measuring glycemic control. Method  A randomised controlled double-blind study.

7. Participants  60 Patients with type 1 or type 2 diabetes and diagnosed with depression.

8. Procedure  Patients were randomly assigned to either a fluoxetine or a placebo group.  Patients were assessed for depression using psychometric tests and their adherence to their medical regimen was assessed by measuring their GHb levels, which indicated their glycemic control.

9. Findings  Patients given fluoxetine reported lower levels of depression.  Patients given fluoxetine had lower levels of GHb, which indicated their improved adherence.

10. Conclusions  Measuring GHb in patient with diabetes indicates their level of adherence to prescribed medical regimes.  Greater adherence was shown by patients who were less depressed.

11. Improving adherence Key study: Watt et al. (2003) Aim  To see if using a Funhaler ® could improve children’s adherence to medication for asthma.

12. Method  A field experiment, although it used children with asthma so could also qualify as a quasi-experiment. The experiment set up two conditions, and then used self-report to measure the adherence rates.

13. Participants  32 Australian children with asthma:  10 males and 22 females;  aged from 1.5 to 6 years;  mean age 3.2 years. Design  A repeated design as each participant had one week using the normal inhaler then one week using the Funhaler.

14. Procedure  Each child was given the Breath-a-Tech to use for one week, and a questionnaire was given for the parents to complete.  In the second week, the children used the Funhaler, and the parents were given a matched questions questionnaire.

15. Findings  38% more parents were found to have medicated their children the previous day when using the Funhaler compared to the normal inhaler.

16. Conclusions  The Funhaler reinforced correct usage of the inhaler with a toy that spins and a whistle that blows.  This did improve the adherence to the medication.  By making the medical regime fun, the adherence, certainly in children, can be improved.