AlignMap In Cites

High-Tech Treatment Adherence « Jessica Land

 Patient responding to news of adherence monitoring device. Excerpt: Terrifying because, well, it might mean I have no way out of taking the drugs. If you’re non-compliant, doctor’s can “fire” you as their patient. Hence the reason many lie. For those who do fess up about their bad practices, there are endless reprisals from the physician. Again, a good reason to lie.

Star-Telegram.com: | 04/21/2008 | Disregarding doctors’ orders The quote in the heading may be my favorite of all the declarations made about improving patient compliance. My second favorite, also from this article, is No one wakes up and says, “Yes, today is a good day for a colonoscopy.”

In addition to offering great quotes, this piece is one of the best articles on noncompliance I’ve seen in the lay press. While it is not all-inclusive, it does also offer outstanding advice for patients coping with a difficult medication regimen (e.g., taking meds that produce severe side-effects). Heck, it’s even inspirational.

Poststroke Depression Does Not Decrease Women’s Compliance With Medications

 After a stroke, women are more likely to become depressed and have poorer quality of life than men, but depressed men are more likely to stop taking their stroke-prevention medications, a new study found. Excerpt: It’s important to recognize that women are more likely to be depressed and to have poor quality of life after a stroke,” lead author Cheryl Bushnell, MD, associate professor of neurology at Wake Forest University School of Medicine, in Winston-Salem, NC, said in an interview with Medscape Neurology & Neurosurgery. “But we’ve been focusing on women recently, and I don’t think we fully understand what’s happening in men. If they’re deciding they don’t need their medications, that’s a problem.”

Strategies to Improve Medication Compliance by Medicare Beneficiaries — Wilensky 117 (10): 1252 — Circulation Quote derives from an editorial on the article referenced in the preceding AlignMap In Cites post. The author of the editorial (an economist) concludes “Low copayments for medically appropriate therapeutics are a fundamental part of value-based insurance. I support the concept. However, pressing for full coverage for specific pharmacotherapy classes on a disease-by-disease basis is not likely to be an effective way to fix the current program. The question is how to best move the current, fragmented, stove-piped system that characterizes Medicare to one that rewards physicians and institutions that provide high-quality cost-effective care to patients.”

I emphasize this conclusion because it is in keeping with my long held, redundantly reiterated stance that piecemeal attempts to enhance treatment adherence are not only intrinsically limited by the scope of that area of noncompliance but also because changes in one area of the healthcare system are likely to have unintended consequences elsewhere in the system that may reduce or even reverse whatever advantages the initial change might have wrought.

My only criticism of the editorial, in fact, is that its focus is restricted to healthcare needs of seniors and Medicare, which is yet another reiteration of the same problem of addressing the compliance issue piecemeal - only with larger pieces.

Reality Check: Why Don’t Fat Women Get Checked for Cancer of the Nasty Bits? | BlogSheroes Worthwhile, impassioned take on one of the issues causing noncompliance (there are a batch of factoids such as those in the quote that ring true and are convincing) that is typically mentioned only in passing. While I suspect that obesity is rarely the only hurdle to adherence, I also suspect, especially after reading this post, that it deserves more attention than it currently receives. In any case, clinicians need to be aware of their own biases and not allow the to interfere with patient care.

From The Introduction: The Rotund points out a recent Reuters article about how clinically obese women are less likely to be screened for cervical, breast, and colorectal cancer. And of course, researchers and journalists just can’t imagine why.

It’s not certain why obese women are less likely to get these screening tests, as few studies have been designed to look at the underlying reasons

Well, here’s one: Stigma and Discrimination in Weight Management and Obesity, by Kelly Brownell and Rebecca Pugh.

The article also references Barriers to routine gynelogical cancer screening for White and African-American obese women, by Amy, Aalborg, Lyons and Keranen.