Hyperglycemia: Medication Non-Adherence & Patient Education
Hyperglycemia. Upon seeing this word, many would instantly think of diabetes. Diabetes is a precipitating factor of hyperglycemia, though it must be acknowledged that coexisting diseases, infections, substance abuses, antipsychotic drugs, and even noncompliance to prescribed medications can result in hyperglycemia as well (Nugent, 2005; Stoner, 2005). Noncompliance, of all mentioned factors, is currently a major issue worldwide, and is generally comprised of the “failure to fill a prescription, taking an incorrect dose, forgetting to take doses, skipping doses, committing errors in dose timing, and stopping the medication prematurely” (Rickles, Wertheimer & Smith, 2010). Why is this occurring? Could the consequences of it really be that detrimental? And if the consequences are fatal, how can non-adherence be “reversed” so that those suffering from the condition will not experience relapses? The answer to these is extremely significant as they aid health professionals in providing holistic and effective care to hyperglycemia sufferers. With effective management, an overall cessation of the multiplication of the condition would be evident on a global scale. This would not only be beneficial for individuals as they are provided with guidance, but would also reduce strains on economic costs (Rickles, Wertheimer & Smith, 2010). There are three main areas that contribute to non-adherence to medications for hyperglycemia: physician-, medication- and patient-related.
Health professionals are the key to the adherence of medication as they diagnose and council the patient on their medication regimen (NCPIE, 2007). Yet, studies have shown that there’s a lack of counseling due to overestimation of the patient’s ability to adhere to the medication and to poor communication between the two parties (NCPIE, 2007). Patients are not properly informed about the medication regime that they are taking – the purpose of it, their side-effects and how to overcome the side-effects – which would result in them feeling uneasy about undergoing proper treatments. In addition, any impairment in the physician-patient relationship would also lead to significant reductions in compliance as trust between both parties has not been established (Winkler, Teuscher, Mueller & Diem, 2002).
The medication regimen itself could be a barrier. This could be due to its complexity, as is the case of undergoing insulin therapy for many (Winkler et. al, 2002), or due to the side-effects of the oral medications ingested. Side-effects result in approximately 45% of discontinuations of medical treatment, as shown in a study conducted in 2005 (NCPIE, 2007).
Even with the undivided support and guidance from health professionals, noncompliance can still occur because of the individual him or herself or his and her external factors. We are humans, and are thus governed by our mindset, mood and emotions (Hernandez-Ronquillo, Tellez-Zenteno, Garduno-Espinosa, Gonzalez-Acevez, 2003; Ramirez & Lopez, 2008). There will be times when medication time is skipped due to forgetfulness (Roberts, 2009); excuses of having no time; fear of side-effects and of needles and self-injections; and even lack of motivation and control over eating (Hernandez-Ronquillo et. al, 2003; Ramirez & Lopez, 2008). More importantly, however, is the individual’s self-perception of their condition, belief in the effectiveness of treatment and the lack of knowledge of what their condition is (Ramirez & Lopez, 2008). In fact, Ramirez & Lopez (2008) states that the medications are only taken upon the onset of clinical manifestations of the condition, such as trembling, due to the lack of knowledge of his or her condition. An interesting contributor to non-adherence is depression, and it is most evident in missed appointments. Studies have shown that...