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Purpose: To study the prevalence and determinants of compliance with spectacle wear among school?age children in South India who were given spectacles free of charge under a school vision screening program. Methods: A cross?sectional, descriptive study was performed. The participants were recruited from the school from Tirunelveli and Tuticorin districts of Tamil Nadu, where a school vision screening camp was conducted between January 2012 and October 2012. The school screening was performed under “Lavelle Pediatric Eye Care Project”. Of the 129,720 children examined of 249 schools, 4253 of children had refractive error and 3333 were prescribed and dispensed spectacles. A total of 683 children were interviewed, who were not wearing glasses on follow?up. Results: About 20% of the participants (683/3333) were not wearing their spectacles at examination. The most common reasons given for non?wear were lost (44.9%) or broken (35.3%) spectacles. There was no gender preference on compliance to spectacles. Conclusion: Compliance with spectacle wear is less even when spectacles are provided free of cost, particularly in children among the age group of 5–15 years. Because factors such as type of school, area (urban or rural), parent’s income, occupation, and their education were not significantly affecting the compliance of spectacle wear, proper encouragement and counseling of the parents and the child become extremely important.
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Diabetic ketoacidosis (DKA) is a medical emergency caused by the lack of insulin. Metabolic acidosis, hyperglycemia, and ketoacidosis are its defining features. Insulin deficiency can cause DKA either in the presence or absence of a triggering event causing a chain of pathophysiological changes. Normalizing volume status, hyperglycemia, electrolytes, and ketoacidosis are the objectivesof DKA treatment. While hospital pharmacists are involved in managing DKA, community or ambulatory care pharmacists can help to prevent DKA. Depending on the particular field of practice, a p harmacist’s engagement in DKA may involve a number of factors. Inpatient pharmacists are in a good position to help with the acute care of DKA. Because they can recognize patients who are at risk for DKA due to factors including medication nonadherence or insulin pump failure, pharmacists in the community or ambulatory-care environment play a crucial role in its prevention. When a patient finds it challenging to navigate prescription plan coverage or a lack of coverage, community pharmacists can help them obtain insulin. Regardless of the professional environment, patient education is essential. Every pharmacist has the ability to give DKA patients thorough medication education that emphasizes the value of adhering to their drug schedule, addresses any obstacles that may occur, and teaches patients how to correctly monitor their blood glucose levels. Studies showed that pharmacists’ medication counseling and treatment monitoring could improve adherence to insulin medication. The aim of this review is to provide evidence that pharmacists can contribute to optimizing medication adherence and decrease the incidence of DKA.
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El cumplimiento del protocolo de lavado de manos evita las infecciones nosocomiales, mientras que el incumplimiento ocasiona consecuencias como el aumento de la morbimortalidad, la estancia hospitalaria, así como gastos adicionales al sistema sanitario y al usuario. Esto se puede prevenir con el lavado de manos que surgió como teoría desde la antigüedad. El trabajo de investigación fue de tipo observacional descriptivo con enfoque cuantitativo y fue realizado en 24 enfermeros de un servicio de salud de la ciudad de Encarnación con el objetivo de evaluar el cumplimiento del protocolo del lavado de manos establecido en el Manual de Prevención y Control de Infecciones asociado a la Atención de la Salud del año 2017 del Ministerio de Salud Pública y Bienestar Social. Los resultados evidenciaron un 54% de incumplimiento en la técnica de lavado de manos, un 44% de incumplimiento parcial y solamente un 2% de cumplimiento. En cuanto a los cinco momentos del lavado de manos, el 85% no cumplió con todos los momentos y un 70% no ha recibido capacitación referente al lavado de manos en los últimos 2 años. Se evidenció un alto porcentaje de incumplimiento del protocolo de lavado de manos, lo que representa un riesgo para la salud que podría subsanarse con la realización de cursos de capacitaciones o retroalimentación a los profesionales de enfermería
Compliance of handwashing protocol avoid nosocomial infections, while non-compliance causes consequences such as increased morbidity and mortality, hospital stay, additional cost to the health system and the patient. This can be prevented with handwashing which emerged as a theory in ancient times. This study was descriptive observational with quantitative approach and was carried out in 24 nurses at a health service in the city of Encarnacion in order to evaluate the compliance of handwashing protocol, established in the Infection Prevention and Control Manual associated to Health Care of 2017 of the Ministry of Health Care and Social Welfare. The results showed 54% of non-compliance in the handwashing technique, 44% of partial non-compliance and just 2% of compliance. In relation to the five moments of handwashing technique, 85% did not follow all the steps and 70% did not receive training regarding to the hand washing technique in the last 2 years. A high percentage of non-compliance with the hand washing technique protocol was evidenced, which represents a health risk, which can be corrected with training or feedback workshops for nursing professionals
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Humans , Male , Female , Adult , Security Measures , Public Health , Cross Infection , Hand DisinfectionABSTRACT
Background: Acute coronary syndrome is the leading cause of cardiac mortality and morbidity world over. Modification of life style pattern and adherence to pharmacotherapy plays a vital role in primary and secondary prevention of coronary events. This study was aimed at assessing the penetration of life style modifications and adherence to pharmacotherapy after acute coronary event in our population.Methods: Acute coronary syndrome patients enrolled in the study were examined, interviewed and all the demographic and clinical data was recorded at index event and at 3, 6 and 12 month intervals.Results: A total of 260 patients were enrolled in the study and followed for 12 months. Mean age of patients was 55.6±8.27 years. Males 78.6% and females 21.5%. Hypertension was risk factor in 67.7%, diabetes in 26.2%, smoking in 63.8%, BMI ≥25 in 67.3% and family history of coronary artery disease in 8.8% of the cases at index event. Uncontrolled hypertension was observed in 30.11%, 38.63% and 44.88% patients at 3, 6 and 12 months follow up. Uncontrolled diabetes at 3, 6 and 12 months was found in 58.82%, 66.17% and 73.52% patients. 5.42%, 15.06% and 21.08% cases continued to smoke at 3, 6 and 12 months respectively. Drug non-compliance overall was noted in 9.61%, 17.69% and 23.84% cases at 3, 6 and 12 month follow up.Conclusions: This study highlights the under prevalence of modifiable risk factor change in practice and drug non-compliance after an acute coronary event.
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Purpose: In this study we tried to analyze the prevalence of non-adherence to radiation treatment, the factors behind the unplanned breaks and the evaluation of strategies to overcome such breaks. Materials and Methods: Between January 2017 to October 2017, 486 patients were registered for radical radiotherapy of which 91 patients with unplanned treatment break were identified. We analyzed the social, economic, educational, and therapeutic barriers that led to treatment interruptions. Results: 91 patients of 486 patients registered for radical radiotherapy with unplanned treatment break were identified. The age of such patients ranged from 30 to 85 years with a median age of 52.5 years. 61 were males and 30 were females. 39 patients were from urban areas and 52 belonged to rural area. Of these 91 patients 85 patients were receiving cashless treatment based on BPL cards and 6 were cash paying patients. 52 Patients had Head and neck, 23 had gynecological, 7 with breast and 4 patients had esophageal cancers. Majority of patients in our study had treatment breaks during the mid to end phase of a radical radiotherapy schedule with the onset of Grade II or III acute reactions. Conclusion: As majority of patients were supported by government schemes without any binding factor, some compelling factors like blocking the BPL cards to avail other benefits, or to impose some kind of penalties to avoid wastage of government efforts and resources.
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Objective According to the study of academic clinical research managed by Peking University Clinical Research Institute,identified problems that existed during the follow up in clinical research.Strategies and methods were proposed after analyzed the related problems,to enhance the quality of follow-up in clinical research.Methods Analysis of common follow-up management problems found in project management and on-site monitoring.Results Strategies and suggestions were proposed,table tools and management software were recommended to investigators for strengthening follow-up management.Conclusions Investigators should follow the scientific validity,research strategy and methodologies during the implementation of clinical research,to make sure compliance to increase the follow-up rates and guarantee the data quality.
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Background: India is the highest TB burden country in the world. In the year 2006, annual performance of revised national tuberculosis control programme (RNTCP) in India, in terms of cure rate of new smear positive patients was 84%, default rate was 6.4% while in Madhya Pradesh it was 82% and 7.6% respectively. Rewa district have poor performance as compare to national level. Non-adherence with treatment has been recognized as an important factor responsible for low cure rate and high incidence of drug resistant TB. The objective of study was to find out the compliance rate with DOTS and associated factors responsible for non-compliance in the district. Methods: The present observational study was carried out at fifteen selected DMC cum DOTS centers of Rewa district, M.P. Results: Of the 337 patients interviewed, majority of patients 270 (80.11%) complied and 67 (19.88%) did not comply to treatment. The main reasons for non-compliance were false perception of having their disease cured because they felt well with initial treatment 26 (38.81%), side effects of drugs 23 (34.33%), anxiety of loss of wages 9 (13.43%) and Migration of patients 7 (10.44%). Conclusions: Repeated counselling and motivation of noncompliant patients would be helpful to reduce noncompliance to treatment.
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A hospital based interventional study was done at Anti Retroviral Therapy centre (ART) of SMS Medical College during August 2010 to January 2011 with the objectives of finding out the proportion of patients who did not adhere to ART, its associated factors, reasons for non-compliance and determine the effect of reinforced counselling through interpersonal communication addressing patient specific reasons and solution for increasing compliance. There were 2841 HIV patients on ART during study period and on an average 381 (13%) of them did not adhere to ART. Age, literacy, unemployment, presence of co-infections were significantly associated with non-compliance while marital status, sex of patient, area of living, family size, distance from ART centre and type of ART regime were not associated with non-compliance. Reasons stated for not coming to collect drugs or not consuming them were mainly patients were travelling, forget to take the pills, no one was there to accompany them, no money for fare, busy in agriculture or other day to day activities. 100 randomly selected non-compliant patients were offered reinforced counselling with focus on patient specific reasons for non compliance and with an intention to encourage the patients to come up with solutions in prevailing circumstances. 74 patients started taking drugs regularly at the end of study. One patient out of these hundred died during study period.
Subject(s)
Adult , Antiretroviral Therapy, Highly Active/methods , Antiretroviral Therapy, Highly Active/trends , Antiretroviral Therapy, Highly Active/statistics & numerical data , Counseling , Female , Humans , Interpersonal Relations , Male , Medication Adherence/epidemiology , Medication Adherence/psychology , Medication Adherence/statistics & numerical data , Middle Aged , Patient Compliance/epidemiology , Patient Compliance/statistics & numerical data , Persuasive Communication , Young AdultABSTRACT
OBJECTIVE: To compare dentoalveolar and skeletal changes produced by the pendulum appliance (PA) and the distal screw appliance (DS) in Class II patients. METHODS: Forty-three patients (19 men, 24 women) with Class II malocclusion were retrospectively selected for the study. Twenty-four patients (mean age, 12.2 +/- 1.5 years) were treated with the PA, and 19 patients (mean age, 11.3 +/- 1.9 years) were treated with the DS. The mean distalization time was 7 months for the PA group and 9 months for the DS group. Lateral cephalograms were obtained at T1, before treatment, and at T2, the end of distalization. A Mann-Whitney U test was used for statistical comparisons of the two groups between T1 and T2. RESULTS: PA and DS were equally effective in distalizing maxillary molars (4.7 mm and 4.2 mm, respectively) between T1 and T2; however, the maxillary first molars showed less distal tipping in the DS group than in the PA group (3.2degrees vs. 9.0degrees, respectively). Moreover, significant premolar anchorage loss (2.7 mm) and incisor proclination (5.0degrees) were noted in the PA group, whereas premolar distal movement (1.9 mm) and no significant changes at the incisor (0.1degrees) were observed in the DS group. No significant sagittal or vertical skeletal changes were detected between the two groups during the distalization phase. CONCLUSIONS: PA and DS seem to be equally effective in distalizing maxillary molars; however, greater distal molar tipping and premolar anchorage loss can be expected using PA.
Subject(s)
Humans , Male , Bicuspid , Incisor , Malocclusion , Molar , Retrospective Studies , Statistics, NonparametricABSTRACT
Background: Non-compliance to treatment, especially medication is an important area of concern in psychiatry as it contributes to relapse and re-hospitalization of the patients. One of the ways to improve drug compliance is to know crucial factors responsible for poor drug compliance so that proper management strategies may be planned to improve patients’ drug compliance Aims: To find out the reasons for drug non-compliance and its association with socio demographic variables and psychiatric diagnosis. Methods: The study was conducted on patients attending psychiatry outpatient department for duration of seven months to evaluate the reasons for treatment non-compliance, using a questionnaire designed for the purpose. Results: In our study, it was observed that 63.75% of subjects were compliant and 36.25% were non-compliant. A significant association was found between non-compliance and age group more than 46 years, female gender, low socio economic class, low education rate. Non-compliance was highest among patients with schizophrenia (45.16%) and the main reason for drug non-compliance identified in the present study was a lack of knowledge about the nature of illness. Conclusion: The result of the study concludes that the major reason for non-compliance was lack of knowledge about the illness reflecting the importance of psycho education. Key message: Lack of knowledge about the nature of illness was the main reason for non-compliance.
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Chronic illnesses are an increasing cause of morbidity and mortality in rural India. Many patients default from treatment, and exploring their reasons for the same may suggest strategies to improve service accessibility and acceptability. A qualitative study was conducted of 22 patient interviews, six key informant interviews, and two patient focus group discussions for investigating the reasons for default at the KC Patty Primary Health Centre and surrounding villages in Kodaikanal Taluk, Dindigul district, Tamil Nadu. The reasons included money or transport diffi culties, frequent travel, feeling healthy, focus on work, fear of scolding from clinic staff, medication side effects, preference for alternative therapy, and depression. Some reasons were only divulged after an extended discussion. Support from families and village-level health workers (VLHWs) were also identifi ed as important. Recommendations include more open and patient communication between health workers and defaulting patients, in addition to recruitment of more VLHWs.
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Objetivo: Determinar los factores implicados en la salida de los pacientes del servicio de urgencias antes de completar el proceso de atención. Material y Método: Estudio retrospectivo, descriptivo y analítico. Pacientes que se retiraron en algún momento del proceso de atención del servicio de urgencias del Hospital General Pediátrico Niños de Acosta Ñu del 01 de enero al 31 de julio de 2010. Resultados: El Hospital recibe por año una media de 45.000 consultas. Durante el periodo de estudio, acudieron un total de 31.823 pacientes. Se retiraron sin ser vistos 1.131 (3,55%). De los cuales 210 se fueron en el pre-triage y 728 en el post-triage, antes de la evaluación médica. 193 pacientes atendidos por el médico se retiraron sin ser reevaluados: 113 no regresaron con resultados de laboratorio, 75 sin reevaluación clínica y 5 en contra del consejo médico, todos atendidos en tiempo esperado, según clasificación de riesgo. 938 niños salieron del Hospital sin ser vistos por un profesional médico. Edad media: 4,7 años. En los meses de enero y febrero, se registraron mayor porcentaje de salidas prematuras 4,26%, la media de pacientes atendidos por mes fue de 4.546. Existió una relación significativa en el hecho de vivir a menos de 5 km y retirarse en el pretriage (RD: -5). El lunes fue el día de más retiradas sin atención completa (246 pacientes, 4,48% del total de 31.000 pacientes del periodo), mientras que el domingo fue el día de menos retiro anticipado (2%). La hora de llegada más asociada con el riesgo de retiro anticipado fue entre las 12:00 y 13:00 horas (p: 0,0023). En pre-triage hubo una demora de 27,5 minutos en promedio. El tiempo de espera para la atención médica en promedio fue de 107,46 minutos: urgentes 61,4 minutos (3,2% ptes.), semi-urgentes 109,6 minutos (91,7%ptes), no urgentes 95 minutos (5%). Manteniéndose una diferencia significativa en los tiempos de espera según clasificación de riesgo. (p: 0,0004).
Introduction: It is important to understand the factors associated with early withdrawal of patients from the Emergency Department. Triage classification by risk level is also vital.Objective: To determine the factors involved in patients abandoning the emergency department before completing the process of care. Material and Methods: a retrospective, descriptive and analytical study. Patients who withdrew at some point in the care process from the emergency room of Niños de Acosta Ñu General Pediatric Hospital between January 1 and July 31, 2010. Results: The hospital attends an annual average of 45,000 patients. During the study period, a total of 31,823 patients presented at the hospital. Of those, 1131 (3.55%) withdrew without being seen. Of those, 210 left prior to triage and 728 left after triage but before medical assessment. Of those seen by a doctor, 193 withdrew without being re-assessed 113 were sent for lab tests but did not return, 75 withdrew without clinical reassessment, and 5 against medical advice; all were seen within the period of time allotted according to risk classification. 938 children left the hospital without being seen by a medical professional. Mean Age: 4.7 years. In the months of January and February a higher percentage (4.26%) of premature withdrawal was noted, while the mean number of patients seen per month was 4546. A significant relationship was found between living within 5 km and withdrawal before triage (SD: -5). Mondays saw the most withdrawals, 246 patients (4.48% of all 31,000 patients for the period) withdraw without completing treatment, while Sundays was the day of the week with fewest early withdrawals (2%). The arrival time most associated with risk of withdrawal was between noon and 01:00PM (p=0.0023). In pre-triage waiting time before triage was 27.5 minutes on average...
Subject(s)
Emergency Service, Hospital , Patient Care , Patient Dropouts , Patient Satisfaction , Emergency Service, Hospital/classification , Emergency Service, Hospital/organization & administration , TriageABSTRACT
Background and objectives: This review focuses on three areas, basic acid-base physiology especially concerning hydrogen ion balance, development of acidosis in chronic kidney disease (CKD), and the consequences of acidosis. We highlight what is well established, what is less certain, and what is unknown. Method and results: The literature on acidosis in CKD were searched from 2004 to 2010 utilizing PubMed, Google Scholar, and Ovid to augment the classic work on acid base physiology over the past three decades. The original research in endogenous acid production and net acid excretion were reviewed. Touching upon the development of metabolic acidosis in CKD, we focused on the consequences of chronic metabolic acidosis on growth and other important variables. Finally, we recognize the significant issue of patients’ medical non-compliance and presented treatment strategy to counter this problem. Conclusion: The correction of acidosis in chronic kidney disease needs no advocacy. The case is made conclusively. Patient non-compliance because of the medication that needs to be taken several times a day is a problem, requiring due diligence.
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O presente estudo objetivou compreender aspectos relacionados à adesão e a não-adesão ao tratamento farmacológico para depressão, envolvendo usuários e ex-usuários de um serviço público de saúde mental. Foram entrevistados, individualmente, 24 pacientes (12 aderentes e 12 não aderentes ao tratamento medicamentoso para depressão). Por meio da análise de conteúdo das entrevistas, identificou-se que o fenômeno da adesão/não-adesão estaria inter-relacionado a aspectos intrapessoais, interpessoais e ao contexto do tratamento do paciente. Os resultados fomentaram reflexões acerca do papel de equipes de saúde mental no incremento da adesão ao tratamento, bem como da necessidade de uma maior consideração do indivíduo, da família e do atendimento prestado pela instituição.
The present study aimed to understand the aspects related to compliance and non compliance to the pharmacological treatment for depression, with users and former-users of a mental-health public service. Twenty four patients were interviewed individually (12 adherent and 12 non-adherent to the pharmacological treatment for depression). Through interviews content analysis, it was identified that the compliance and non-compliance phenomenon would be inter-related to intrapersonal aspects, interpersonal aspects, and to the context of the patient's treatment, The results contributed to reflections concerning to the role of mental health teams in enhancing treatment compliance, as well as to the need of a greater consideration of the individual, the family and the community, and the assistance provided by the institution.
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Humans , Male , Female , Adult , Depression , Mental Health , Medication Adherence , Patient Dropouts , Treatment RefusalABSTRACT
Introdução: A não-adesão à terapia imunossupressora é um fenômeno que ocorre após o transplante renal em todas as faixas etárias, predominando na população pediátrica e nos adolescentes. O assunto é muito importante, pois implica em aumento do risco de rejeição aguda tardia e perda do enxerto. Objetivo: O objetivo deste estudo foi revisar a literatura a respeito da não-adesão ao tratamento medicamentoso após o transplante renal. Métodos: Foi realizado um levantamento bibliográfico do período de janeiro de 2000 a julho de 2007 nas plataformas de dados SciELO, PubMed, LILACS e MEDLINE utilizando descritores relacionados a esse tema. Resultados: Não há uma definição consensual do termo não-adesão. Os estudos disponíveis utilizaram uma variedade de instrumentos combinados para mensurar a adesão ao tratamento imunossupressor. Este fato certamente influenciou as diferenças na prevalência de não-adesão encontradas nos estudos, bem como na escolha das estratégias para evitá-la. Apesar dos autores concordarem que múltiplos fatores interferem na ocorrência de não-adesão em pacientes transplantados renais, existe discordância no que tange à qualidade desses fatores. Destacam-se os seguintes: idade do receptor, raça, gênero, nível socioeconômico, tipo de doador, relação médico-paciente, tempo de transplante, complexidade da doença e fatores psicossociais. Conclusão: Não está estabelecido um padrão-ouro para mensuração e prevenção da não-adesão. Entendê-la como um processo que perpassa por diferentes "saberes" parece um caminho a ser percorrido para melhor compreensão e atuação frente a esta relevante questão.
Introduction: Poor compliance with immunosuppressive treatment is seen after renal transplantation in patients of all ages, but it is more common in children and adolescents. This is an important matter because it increases the risk of late acute rejection and graft loss. The objective of this study was to review the literature on non-compliance with drug therapy after renal transplantation. Methods: SciELO, PubMed, LILACS, and MEDLINE databases from January 2000 to July 2007 were reviewed using descriptors related with this subject. Results: A widely accepted definition of non-compliance does not exist. The studies available used a variety of combined tools to measure compliance with immunosuppressive treatment. This, most likely, influenced the differences seen in the prevalence of non-compliance in patients after renal transplantation, as well as the choice of strategies to prevent it. Although the authors agreed that multiple factors interfere with the incidence of non-compliance after renal transplantation, they do not agree on the quality of those factors. Among those factors, we should mention: receptor age, race, gender, and socio-economical status, donor type, physician-patient relationship, time after transplantation, disease complexity, and psychosocial factors. Conclusion: A goldstandard method to measure and prevent non-compliance does not exist. The understanding that non-compliance is a multifactorial process seems to be the way to better understand and prevent this complex issue.
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Humans , Male , Female , Child , Adult , Immunosuppressive Agents/therapeutic use , Renal Insufficiency/therapy , Pharmaceutical PreparationsABSTRACT
Objective: This study aimed to determine the association between the personality traits and social factors with compliance to anti-hypertensive pharmachotherapy. Methods: This cross sectional study was conducted from 1st of June until 31st of December 2004, which involved Hospital Universiti Kebangsaan Malaysia Primary Polyclinic in Bandar Tasik Selatan, Cheras and Salak Polyclinic in Sepang, Selangor. A total of 200 patients who fulfilled all the inclusion criteria, were selected as respondents. This study used the Mini International Neuropsychiatric Interview (M.I.N.I) for the psychiatric diagnoses and personality characteristics were assessed by using Personality Assessment Schedule (PAS) Results: The prevalence rate of non-compliance was 38.5%. Paranoid personality trait (27.3%) was the most common type of personality traits that associated with non-compliance to the medications prescribed. The results of this study revealed a statistically significant difference between drug compliance and age, race, gender and the site where the study was conducted. No association was found between patients’ education level, occupation, income, marital status, family history of hypertension and personality traits and drug compliance. Conclusion: This study suggested that drug compliance among hypertensive patients was influenced by the presence of psychosocial factors. Hence, it is important for medical practitioners to understand these factors and administer treatment more individual.
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La tuberculosis (TBC), actualmente declarada como una urgencia mundial, enfrenta un obstáculo muy importante para su control: el abandono del tratamiento, también llamado no adherencia, incumplimiento o falta de apego del paciente a la medicación. Implica graves consecuencias tanto para el enfermo, como para la comunidad, debido a que el paciente no se cura y continúa la cadena de transmisión de la enfermedad. Adicionalmente, la bacteria puede desarrollar resistencia a los medicamentos disponibles para el tratamiento, aumentando costos del mismo y la morbimortalidad de los pacientes. Las cifras de abandono en el mundo están reportadas entre 0 y 85%; para 1995, la OMS reportó una proporción general de abandono para América del 6%: en Colombia se registró un 24% de abandono entre 1982-83 y 10% entre 1988-89. Estas cifras están por encima de las expectativas de la OMS (5%). En este artículo se revisan los factores de riesgo relacionados con el paciente, el tratamiento, el ambiente y los servicios de salud.
Risk factors to non-compliance with TB treatment Tuberculosis (TB), at present declared as a world emergency, faces a very important obstacle for their control which is the abandonment of treatment. It´s also called no compliance, no adherence, or, simply, the patient misses his medication. This has a serious consequences as for the sick person, as wells as for the community, because the patient is not treated and the transmission chain continues; in addition, the bacteria may develops resistance to current medications. This will Increases treatment costs, as well as, patient morbidity and mortality. The abandonment rates in the world are reported, being, among 0 to 85%. For 1995, WHO reported a general proportion of abandonment for the Americas, being of 6%; In Colombia, we have a registered 24% of abandonment between the years of 1982 to 1983 and 10% among 1988 to 1989. These rates are above the WHO´s expectations which are less than 5%. The abandonment associated with high incidence becomes a problem for public health of such as big dimensions. In this article we discuss the epidemiology of non compliance, the risk factors related with the patient, the patients treatment, the social environment and the health services.
Subject(s)
Humans , Mycobacterium tuberculosis , Risk Factors , Treatment Refusal , TuberculosisABSTRACT
BACKGROUND: The secondary prevention of stroke which is defined as the control of risk factors and continuous antithrombotic therapy if indicated plays an important role in decreasing stroke recurrence. Unlike most developed countries, the stroke mortality in Korea has yet to be on the decline. It is well known that treatment non-compliance for secondary prevention after a stroke is associated with stroke recurrence and poor functional outcome. There has been no investigation about outpatient treatment compliance of Korean stroke patients who were previously hospitalized. This study aimed to explore the behavior and preference for treatment of stroke patients after discharge and to assess the recurrence rate of stroke for those patients who were not compliant with therapy for secondary prevention and their reasons for not being compliant. METHODS: Study subjects included three hundred thirty-eight stroke patients who were admitted to the Hallym Stroke Center between Jan. 1 and Dec. 31 of 1995. Those who died during hospitalization and those who were discharged to go home on impending death were excluded. The mean age was 63.6 years and the male to female ratio was 1.2 to 1. Telephone inquiries were performed with patients or caregivers regarding the recurrence of stroke, the reasons for non-compliance with secondary preventive management and other kinds of care they received for stroke. RESULTS: Among two hundred six patients (60.9%) not given a follow up on the out-patient basis, 110 patients completed telephone interviews and 102 patients were found to be non-compliant. Nineteen patients (17.7 %) of this non-compliant group reportedly had a recurrent stroke. The age, level of education, and Rankin score were factors which influenced the compliance of patients. Non-compliant patients were currently under the care of: 1) oriental medicine and/or acupuncture (n=56); 2) alternative medicine (n=17); 3) inadvertent over-the-counter drugs (n=16); and 4) no treatment at all (n=26). The reasons for non-compliance included: 1) biased preponderance of oriental medicine (n=44); 2) ignorance about the importance of secondary prevention (n=36); 3) inconvenience of the bureaucratic procedure of hospitals (n=34); 4) economic burden (n=17); 5) dissatisfaction with medical care (n=10); and 6) other reasons (n=6). CONCLUSIONS: Secondary prevention care for Korean stroke patients seems to be inadequately achieved. The proper education of patients and their caregivers about the importance for the secondary prevention of stroke is needed to decrease stroke recurrence in Korea.