POOR MEDICATION ADHERENCE IN TYPE 2 DIABETES 

POOR MEDICATION ADHERENCE IN TYPE 2 DIABETES

Introduction  

Approximately 45 % of patients diagnosed with Type 2 diabetes (T2D) fail to achieve glycaemic threshold control. The failure has been attributed to poor mediation adherence. Polonsky and Henry (2016) document that poor medication adherence in T2D is widespread, and it is associated with increased costs of outpatient care, hospitalization, emergency room visits, increased mortality and morbidity, inadequate glycaemic control, and managing diabetes complications. This essay, however, links poor medication adherence to key non-patient factors, including lack of clinical inertia among health care practitioners and care in various health care systems. In T2D medication adherence, specific barriers, especially those that are potentially modifiable, should be identified clearly; approaches meant for poor medication adherence should focus on addressing negative medication beliefs and reduce medication encumbrances

Critical Analysis

Diabetes is a disease that affects the body’s ability to produce or be able to use the insulin that turns the food that we eat into energy. Worldwide, the prevalence of T2D is at epidemic proportions. Its incidence and prevalence and incidence continues to rise. According to the International Diabetes Federation (2014), the worldwide incidence of this disease will increase from 382 million people to 417 million people by 2035. The Federation’s survey is of critical concern as T2D embodies the most prominent budget element in many health care systems due to the high morbidity and mortality rates associated with it. Even worse, T2D medication costs have been inexorably increasing worldwide (Seuring, Archangelidi, and Suhrcke, 2015).

Chronic poor metabolic control, particularly poor glycaemic control, is seen as the main contributor to the remarkably high mortality and morbidity rates. Despite the various options available for treating T2D, including novel pharmacological classes of drugs in the European Association for the Study of Diabetes, approximately 50 percent of individuals with T2D fail to attain the glycaemic control threshold (Ali et al., 2012; Ford, 2011). Among the various factors contributing to poor glycaemic control, it is apparent that meager medication adherence looms large (Egede et al., 2014). In essence, what are the barriers and challenges that T2D health care providers and patients face regarding medication adherence? What are the potential future approaches to enhance long-term persistence and medication adherence?

Major Contributors to Poor Medication Adherence

Based on large claim databases, Curkendall et al. (2013) and Kirkman et al. (2015) affirmed key demographic factors including lower education level, younger age, and lower-income are associated with poor medication adherence in T2D. However, it is of great significance to identify those critical factors that are modifiable. In total, the current data body points to medication beliefs, treatment complexity, and convenience, perceived treatment efficacy, cost of treatment, hypoglycemia, and physician trust. It should be noted that many other additional factors, including forgetfulness, depression, and limited diabetes knowledge, have been described in the extent of various kinds of literature to be among the contributing factors to the poor. T2D medication adherence but the aforementioned factors may not only be the most critical but also the most amenable to change.

Some of intentional patient non-adherence to medication-taking include cognitive factors, beliefs, ignorance, and knowledge. The cognitive factors include self-efficacy and perceived control abilities by the patient. Studies have shown that patients who have a strong belief in their personal ability to manage the diabetes condition produce the best outcome, unlike those who do not belief in themselves. For instance, Polonsky and Henry (2016) affirms that patients are more likely to adhere to medication systems when they have sense that the prescribed medication is contributing to instant and progressive outcomes. Also, in the trends in social spheres, education level is considered among the social classes (Gonzalez, Tanenbaum and Commissariat, 2016, p.539-551). Individuals with high education levels will have idea of how the blood regulation works and the role of healthy diet in managing the condition. The education of family members and friends will help a diabetes patient actively manage the diabetes condition through supportive medical care and favourable diet.

According to Wiebe, Helgeson, and Berg (2016), the sociological theories on behavioural skills, self-control, self-regulation, and coping determine the ability of a patient to adhere to diabetes treatment and is another intentional factor. The social problem-solving and coping skills are cognitive traits that an individual can learn from environment or society. Coping and behavioural skills make an individual trainable and adhere to a given pattern of life (Wiebe, Helgeson and Berg, 2016, p.526). A family whose members have high cognitive skills will help manage diabetes patients effectively. Moreover, a patient with high cognitive ability will have high self- management practices with the condition thus giving positive outcomes in diabetes management. An individual with low cognitive and problem-solving skills will not effective model the best workable plan for disease management.

On the other hand, Individuals from socially disadvantaged families and regions are likely not to adhere to diabetes treatment. Such patients rarely benefit from glycaemic control but have high risk of heath related complications. The treatment cost has been reported by patients across all regions of the world as a significant barrier in the self-management of the disease thus hindering adherence to treatment and preventive care of diabetes. Notably, children from socio-economically disadvantaged regions and households can rarely afford insulin pumps as an alternative to multiple daily injections; thus, children from socially disadvantaged families who suffer Type 1 diabetes are unlikely to show adherence trends in diabetes management. Besides, adults with Type 2 are likely to suffer hypoglycaemia than individuals from wealthy families showing lack of adherence to treatment.

Family is another unintentional non-adherence to medication-taking in diabetes, it is a social unit that influences the management of diabetes. Family has factors such a cohesion, financial status, and conflict. With advancement in technology and informatics, health practice adopts telemetry in managing chronic and lifestyle diseases. Diabetes and high blood pressure require health services that are expensive for a health provider to maintain. Hence, a comprehensive approach that encompasses the families is adopted in the management of the diseases. However, families that experience general conflict and poor parenting behaviours are unlikely to adhere to diabetes treatment plan (Wiebe, Helgeson and Berg, 2016, p.526).

When taking care of a diabetic child, the family needs high level of understanding between its members since children are always irrational in their actions and behaviours. Cultural beliefs of a person or a society is unintentional factor to non-adherence to medication-taking which affects diabetes treatment and management (Lynch et al., 2012). Some individuals hold decidedly highly skeptical belief about their prescribed medications fearing that the long-term risk outweigh any probable benefits. Individuals from ethnic minorities are likely to be sceptical about the treatment practice. The patients from socially challenged individuals are likely to belief in drug side effects and drug dependencies, which can contribute to medical treatment adherence disparities across different cultures. Therefore, such individuals are likely to accept routine medication plans. Latino diabetes patients are unlikely to adhere to treatment due to beliefs that insulin causes blindness (Lynch et al., 2012).

The extreme cultural beliefs and religious doctrines affect the adherence to treatment by patients. Religiously, there are patients who abandon the treatment plan to seek divine intervention through prayers. Also, there are religious groups that discourage their members from seeking hospital-based treatment but recommends prayers and other unconventional approaches that are not scientifically supported (Swihart and Martin, 2019). In some remote parts of the world where primitive cultures are still in place, cultural and traditions impair the adherence to diabetes treatment. There are societies of the world that beliefs in spell and bewitching when an individual is struck by illness, thus always seek divine cultural remedies instead of adhering to treatment plans. However, the studies show that the cultural difference between the health providers and the patients is the main cause of lack of adherence among diabetes patients.

Doctors-patients’ relationship

This is the major ethical issue in the medical field whereby there must be proper communication among the two entities. The relationship of Effective communication between the doctor and patient has positively impacted the aspect of health consequences of patients complying with medics’ treatment better than before. Consensus is when there is an agreement has been reached after a spirited disagreement between the doctor and the patient. A conflict is the disagreement between the patient and the doctor. Negotiations are procedures that are taken when there is a disagreement so that the doctor and patient can make a solution.

There is a scenario where the patient and the doctor are at loggerheads they have to resolve the mess. Such instances happen when there is wrong prescription and taking of a wrong dosage. Proper communication and exchange of ideas will uphold negotiations between the parties thus bringing consensus. Through such negotiations the patient-doctor relationship can gain more trust and confidence on the assessments that are taken by the doctor. When there are negotiations the patient will can settle down and have the trust of the doctor so that he can apply the guidelines of the doctor.

The Challenges in Achieving Concordance.

Concordance refers to a consultation process between a health care professional and a patient. Improved concordance promotes greater success in managing the person with diabetes and any given disease (Stevenson and Scambler 2005, p, 5-21).  Several factors have been attributed to failure of concordance such as failure of communication between the health care provider and the patient, this is associated with language barrier and patient ignorance. Because, the control of the diabetes condition involves self- regulatory process that largely depends on self-efficacy. When a health provider lacks social and communication skills managing a patient may be challenging; likewise, a patient with low communication and cognitive abilities will impair the consultation process for the diabetes treatment plan. Lack of patient enough knowledge to participate as a partner is also another factor affecting concordance, and this is particularly among the elderly patient who do not understand even what they are suffering from even if they are explained by the clinician.

Lastly is lack of patient support in taking the prescribed medication, patient support is very important in achieving concordance (Stevenson and Scambler 2005, p,5-21). Most diabetes patients face the challenge of lack of support from their families, especially where their cultural belief does not allow a patient to take medication. Such patients are very difficult to be handled by the clinician, since even if they are prescribed certain medicine, they may end up not taking after reaching home due to their cultural and family beliefs