Working in partnership with patients/ clients who self administer medication
A literature review
Self-management has become a concept adopted by the Department of Health (DH) to enable people with chronic health conditions to become the controlling entity over their illness therefore promoting independence and psychological well being. Initiatives that recommend this practice are National Service Framework for chronic disease management and self-care (DH 2002) and National Service Framework for Long-Term Conditions (DH 2005). Part of the framework plan is to implement a strategy to enable people to self-administer their own medication. This includes self-medicating in the community and in acute hospitals.
Compliance and Concordance are terms often used to define principles of self-administering. One must understand their meaning to understand their relevance. Compliance is a word used to describe the act of conforming to a task and non-compliance is a refusal or failure to conform. Concordance is defined as an agreement, a harmony of membership, which can be further implied as a partnership between a couple or group (Soanes and Hawker 2005). The word compliance can be seen to have negative connotation as the act of compliance suggests that one person requires the other to conform by using their perceived higher power. Concordance on the other hand is an equal negotiated consent.
The literature review will look at the nurse’s role in working in partnership with a patient to manage their medicine. A literature review of current peer reviewed articles will allow debate over issues relating to compliance and concordance. Databases used in the literature where CINAHL, OVID and Cochrane Library which offered primary and secondary source, recent publications were used dated between 2002 and 2007. Key words were Self-administration, self-medicating, medication management, and medication with links to adherence, partnership, safety, concordance and compliance.
Published literature was barely sufficient in quantity suggesting an increase in research to provide more evidence. Some studies found it difficult to obtain quality measure to acquire results, most relied on pill counting and honesty, true results would need repeated blood tests or urinalysis which is invasive, and this may be the reason why available research is poor (Orwig et al. 2006:666).
Medicines are a therapeutic regimen in the act of improving health. 713.5 million Prescriptions were dispensed in England and Wales in 2005-06 (The Information Centre 2006). Medication use is rising with a demographically older population but for many reasons only 50% take their medication correctly (Carter and Taylor 2003 cited by NPC 2007:7). These figures suggest a reason to focus on improvement within NHS to reduce wasted resource and improve adherence.
Non-compliance to a drug regimen can create a number of problems for the patient as their therapy may fail, the disease process can advance and in some cases drug poisoning and/ or loss of life (McGarry Longue 2002:54). Many barriers exist to hinder adherence; unwanted side effects, high cost and complex doses and/or large doses. Practical difficulties include physical and sensory problems due to advanced age, disability, cognitive/ memory impairment and mental health issues (Simpson 2006:2614, Loveridge 2005:18). Some barriers can be based purely on social reasons i.e. how a drug regimen will fit in with lifestyle (NPC 2007:7).
Nurses can provide a pivotal role in encouraging concordance where other practitioners such as consultants or general practitioners do not have time allowance. The role of nurse prescriber in the future may be ‘key’ to ensuring safe continuity of care through pharmaceutical education interim assessment (Reddy 2006:468).
Pharmaceutical nurse involvement would be beneficial during transition between acute and community care. Often on discharge communication and drug...