Clear up misconceptions for better compliance
Clear up misconceptions for better compliance
Patients don’t always adhere to regimen
Medications can be a key component of diabetes management. While some patients with Type 2 diabetes can control the disease with proper diet and exercise, others must take oral medications or insulin injections.
"For people with Type 1 diabetes, insulin is a must. For people with Type 2 diabetes, if they need either pills or insulin, it is also very important they take the right type of medication in the right amount at the right time of day to keep good blood glucose control and prevent very serious complications for diabetes," says Maria Gough, RN, CDE, nurse manager for the Diabetes Care Center at South Miami Hospital.
Some of the new medicines for Type 2 diabetes can take up to three months to control blood glucose levels, and missed doses could disrupt the effectiveness of the medication, says Joy Springer, RN, BSN, CDE, CANP, nurse clinician for diabetes at Northwestern Memorial Hospital in Chicago.
Although medications are important to diabetes management, patients don’t always adhere to the treatment regimen. There are many reasons why.
Sometimes the patient is simply in denial, says Trish Neel, RN, BSN, CDE, program manager for the Center for Wellness and Prevention at The Ohio State University Medical Center in Columbus. They may not have any symptoms that they associate with diabetes so they don’t see how medication will make a difference. Also, they aren’t told the significance of their medication. "A lot of patients don’t understand the importance of the medications in terms of preventing complications," she explains.
Other barriers to medication compliance include apprehension about side effects such as low blood sugar, a fear of needles that makes the delivery system bothersome, and the cost of the medications, says Springer.
Often misconceptions about medication hamper compliance. "There are some people who think that if your blood sugar is high, you should take your medications, and if your blood sugar is low, then you don’t need to take your medicine," says Springer.
Some patients may not understand that once they finish a prescription, they need to refill it. They think that the one prescription is all they needed, adds Neel. Others believe that when their blood glucose is normal, they don’t need to take their medication, yet it is the medicine that is helping to keep the blood glucose within the normal range, says Gough.
Assess first, educate second
To address those barriers and improve compliance, an extensive assessment must be part of the education process. This assessment should uncover what the patient is currently doing to stay healthy and how he or she normally takes medication. The information is important because the educator and patient must create a plan that is agreeable to the patient, says Springer. "It may mean taking one medication that has a once-a-day dosage. There is a lot of negotiation in the process," she says.
During the assessment, the educator must determine how much knowledge and skills patients already have, their beliefs and attitudes about diabetes and what cultural influences might impact compliance, what kind of support system they have, and what would motivate them to be compliant, says Gough. For example, if the patient enjoys hiking, being able to continue that recreational activity would motivate him or her to adhere to the medication regimen.
It is important for the patient and educator to negotiate realistic goals by the end of each education session that can be achieved. For example, if the patient doesn’t want to inject insulin in the abdomen, the educator and the patient would find a solution, says Gough.
During the education session, patients need to understand how a particular medication impacts the pathophysiology of diabetes. "For some people, it may be just as simple as saying that it lowers the blood sugar, but others will want to understand it completely," says Neel.
Side effects are covered
Also important is knowledge about the side effects of the medications and what to do if they occur. Another key piece in the education process is blood glucose monitoring so people can see the benefit of the medication, says Neel.
Sometimes when blood glucose is brought to within normal range, patients experience symptoms of low blood sugar because they are having a shift they are not used to, explains Neel. It is a matter of patients learning what is normal and what is not. That’s one reason follow-up education is important. While patients need to enroll in an education program when diagnosed, the learning process never ends and education should take place each time they see their physician.
Learning is voluntary
However, learning is something that is voluntary. "People must be willing. Also, they must feel that they are capable of learning and controlling diabetes," says Gough. (For more information on self-efficacy, see cover story.) If they are preoccupied with some other major problem, such as a need to have open heart surgery, it will be difficult for them to learn, she says.
It’s a good idea to link the patient with educational resources for ongoing education.
There are many journals written for consumers that provide information on the latest research and an element of support. This includes the journal published by the American Diabetes Association, as well as those published by drug and blood glucose meter companies. (For a list of journals, see box on p. 107.) "We also encourage people to attend a support group," says Springer.
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