Heart Fail Rev. The results were extracted according to the type of evidence synthesis. Health Policy Institute. https://doi.org/10.1186/s13643-019-1014-8, DOI: https://doi.org/10.1186/s13643-019-1014-8. 5. 2018;8(1):e016982. It is usually advised for a fracture patient to have a low-fat diet with meager amounts of protein and rich in calcium to promote healing and general well-being. Cancer Treat Rev. The common signs and symptoms of knowledge deficit are: Factors that may contribute to the development of deficient knowledge include: Patients might say I do not need your help, I already know this condition before, or I have no idea what the doctor is explaining to me which are perceived as symptoms of deficient knowledge. Based on these criteria, the effects were rated as robust evidence for an impact, some evidence for an impact, probably no impact or uncertain impact. Vrijens B, de GS, Hughes DA, Przemyslaw K, Demonceau J, Ruppar T, et al. Data were extracted in standardized tables previously piloted by one reviewer and verified by a second reviewer. For co-payments (any co-payment and higher co-payments), the effect direction was almost always negative. 8. Would you like email updates of new search results? We tried to prevent strong heterogeneity by focusing on factors for which we assumed homogeneity across different conditions and considering only implementation adherence to oral drugs. The Nurse practitioner, 43(8), 4955. Include family as requested.Some patients may depend on family members and spouses for support. Medication Adherence and Compliance. We performed a systematic literature search in MEDLINE (via PubMed) and Embase (via Embase). 2009;13(2):11523. Manage Settings A comparison of the individual SRs shows that only three SRs were at low risk of bias in all four domains [25, 27, 28]. NurseTogether.com does not provide medical advice, diagnosis, or treatment. knowledge deficit related to medication compliance. 2008;11(1):447. Assess readiness to learn. First, this information can support the identification of patients at high risk for non-adherence. The moderate to high risk of bias in the included SRs and the exclusion of 78 reviews due to missing quality assessment of included primary studies indicate that there is a need for more methodically sound research to provide stronger conclusions. Categories . It would be prudent to educate the patient about the presence of hypertension, as well as giving insights of the possible change in lifestyle. The influence of the socioeconomic status was uncertain in inflammatory arthritis and patients taking oral anticancer agents [28, 38]. Medication adherence influencing factorsan (updated) overview of systematic reviews, \( \mathrm{CCA}=\frac{\left(N-r\right)}{\left(r\times c-r\right)} \), https://doi.org/10.1186/s13643-019-1014-8, http://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf;jsessionid=5533CE0804BE2E0722B919623C4C2E05?sequence=1.Assessed, https://www.bristol.ac.uk/media-library/sites/social-community-medicine/robis/robisguidancedocument.pdf.Assessed, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. To ensure an objective assessment, the risk of bias assessment of these SRs was performed by a reviewer other than TM. The evidence synthesis indicates that belonging to an ethnic minority seems to be associated with reduced adherence. An official website of the United States government. Some factors can have an influence on intentional non-adherence (conscious decision not to take the medication; e.g., because of high co-payments), while others can have an influence on non-intentional (forgetting) non-adherence (e.g., forgetfulness because of mental comorbidity). Have the patient learn by assessing current knowledge on the diagnosis, disease process, possible aggravating factors, and necessary treatment. Mathes T, Antoine S-L, Pieper D. Factors influencing adherence in hepatitis-C infected patients: a systematic review. Finally, 21 SRs were included in this overview [20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40]. A knowledge deficit in HF patients was also found in the study of De Geest et al., 28 in which 82% reported a knowledge deficit on HF symptoms and 42% on diet prescriptions. Advise to stop taking/start taking/change administration of medications B. In the case that the included SR performed only a narrative synthesis, we used modified vote counting to extract the results. The evidence for an impact of education on adherence was uncertain for most diseases/therapies. Please read our disclaimer. The authors declare that they have no financial competing interests. Bushman B, Wang M. Vote-counting procedures in meta-analysis. Alsabbagh MHDW, Lemstra M, Eurich D, Lix LM, Wilson TW, Watson E, et al. One might argue that this suggests that the influence of these factors dependents on condition or setting. Unless otherwise indicated, all described methods were specified before conducting the overview. Grimshaw J. Schfer C, editor. Establish priorities.A patient may be dealing with a new diagnosis, diet, medications, and post-surgical instructions all at once. > knowledge deficit related to medication compliance. Phase 1 aims to assess the relevance of the SR. For this purpose, the relevance of the research question should be assessed. 2. 2017;129:115. Some evidence for a positive impact was exclusively noted in HIV-infected patients [32, 34]. Adherence is a multifactorial phenomenon that can be influenced by various factors. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. We used the Risk of Bias in Systematic Reviews (ROBIS) tool to assess the included SRs [16]. 2016;90:1032. Nurses Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). 2018;23(3):20015. An inspirational, peaceful, listening experience. We rated the overall risk of bias for eight SRs as low and for 13 SRs as high. Deficient knowledge is defined as the lack of cognitive information or psychomotor ability for the restoration, preservation, and promotion of health. Impacts of other mental and physical comorbidities were uncertain. 2014;14:203. 2018;200:519. Non-adherence is costly for the health service, both through wastage and increased ill health. Unable to load your collection due to an error, Unable to load your delegates due to an error. 2 Poor adherence has been . Moreover, the knowledge of influencing factors of adherence can support the development of tailored health technologies to increase adherence by treating the underlying barriers (e.g., depression treatment, reducing co-payments). 6. Psychological causes such as depression and disordered eating. In particular, imprecise eligibility criteria, inadequate restrictions in the eligibility criteria, inappropriate search strategies, simple vote-counting and no protocols available were the most common reasons for the high risk of bias in these domains. Whiting P, Savovi J, Higgins JPT, Caldwell DM, Reeves BC, Shea B, et al. AG contributed to the study selection, data extraction, risk of bias assessment, data synthesis, writing manuscript and final approval of the version submitted. 176-178, 50935, Cologne, Germany, You can also search for this author in This overview is a focused updated version of an overview published by our research team in 2014 [12]. This equips the patient with knowledge, promotes compliance in treatment, and allows learning for identifying alarming signs or symptoms should there be a need for a change in medications or administration of medicine. Wiesbaden: Springer Fachmedien Wiesbaden; 2017. In primary studies, we considered in particular adjustment for confounding, missing data and adherence measurements, Imprecision (statistical certainty, amount of information on a certain factor [number of primary studies and SRs, effect size)]), Inconsistency (within and between SRs, e.g., due to different adherence measures). 2014;38(3):21426. knowledge deficit related to medication compliance. St. Louis, MO: Elsevier. Ann Intern Med. Always incorporate the family in discussing the treatment plan as much as possible. It may include any of the three domains: cognitive domain (intellectual activities, problem-solving, and others); affective domain (feelings, attitudes, belief); and psychomotor domain (physical skills or procedures). Arch Public Health. 2009;43:41322. Repetition is key.When patients are dealing with stressful illnesses and procedures, they may not always recall or completely comprehend teaching. We extracted information on the effect direction, total number of included primary studies showing a certain effect direction, statistical significance of primary studies (p<0.05) showing the effect direction and total number of primary studies that analysed a certain factor. how many zombies have been killed in the walking dead. Cancer Epidemiol. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Of the 21 included SRs, 14 only synthesized the results narratively, and seven performed a meta-analysis. This nursing diagnosis recognizes a patient's need for guidance and information about a new medical condition. Non-adherence may be intentional or non-intentional, and many factors affect an individual's compliance with a medication regimen. In addition to these pre-defined eligibility criteria, a further criterion was defined post hoc during study selection. 2013;43(1):1828. Desired Outcome: The patient will verbalize ones understanding of disease process and possible treatment plan, as well as the familiarity of the drug adverse effects and possible complications. Create a quiet learning environment.Teaching should not be attempted in certain situations. Duration of disease was the only disease-related factor considered in this overview. Dtsch Med Wochenschr. When the trip is inevitably arduous and tiresome, the patient is advised to carry a bag or backpack to prevent unnecessary muscle fatigue especially when the patients arm has casts. Assess the patients current knowledge about hypertension and obstacles to learning. The site is secure. Instruct the patient to avoid alcohol, smoking, and caffeinated drinks. Three SRs were rated to be at high risk of bias in all domains [22, 32, 36]. Mayo Clin Proc. A total of 28% of all patients thought they had to drink more in case of thirst. Compared with the previous version, this focused update increases the certainty of evidence for some factors (e.g., co-payments or ethnic status) and identifies new evidence on other factors (socioeconomic status, depression and insurance status) [12]. Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, et al. 2016;69:22534. Factors associated with medication adherence among patients with diabetes in the Middle East and North Africa region: a systematic mixed studies review. To speed up the recovery and maximize the healing process, it is advisable that the patient should refrain from moving and let the relative or caregiver act for the patients needs. Adherence measurement and patient recruitment methods are poor in intervention trials to improve patient adherence. Deficient knowledge is defined as the lack of cognitive information or psychomotor ability for the restoration, preservation, and promotion of health. Int J Cardiol. Saini S, Schoenfeld P, Kaulback K, Dubinsky M. Effect of medication dosing frequency on adherence in chronic diseases. However, for most factors, the evidence was not conclusive due to the risk of bias, inconsistency or imprecision. Manage cookies/Do not sell my data we use in the preference centre. We thank Stefanie Bhn for her support in the risk of bias assessment. The CCA can assume a value between 0 and 100%. For all factors, a summary evaluation of the influence on adherence across SRs was made. Unhealthy lifestyle choices. In addition, the corrected covered area (CCA) was calculated. Nursing Diagnosis: Deficient Knowledge related to lack of exposure/recall, misinterpretation of information, or denial of diagnosis secondary to hypertension as evidenced by inaccurate follow-through of instructions and verbalized inaccurate information. Surgery induces inflammation and prompts for extensive healing, so having a diet full of components promoting healing can speed up the recovery. 2012;65(12):126773. The https:// ensures that you are connecting to the This optional phase was skipped in this overview because the relevance was already completely covered by the eligibility criteria. Determinants of adherence to heart failure medication: a systematic literature review. D. Knowledge deficit related to medication compliance. Google Scholar. There is sufficient evidence that depression and co-payments have a negative impact on adherence. Discuss potential benefits and harm that may result from non-adherence C. Talk to pharmacist about the problem D. Address performance/knowledge deficit E. All of the above F. All but C 4. 2023 BioMed Central Ltd unless otherwise stated. Therapy-related factors (e.g., intake regime) and disease-related factors (e.g., duration) mostly showed no impact on adherence. 2015;93(1):2941. Third, it can support the development of individually tailored adherence-enhancing interventions. FOIA In contrast to our previous search filter, we included unspecific terms for influencing factors (e.g., factors, predictors) as well as specific terms (e.g., gender, age) because we focused only on certain pre-defined influencing factors (for the reasoning, see the Study Selection section). statement and Tuberculosis Nursing Diagnosis and Nursing Care Plan, Disturbed Sleep Pattern Nursing Diagnosis and Care Plans, Exaggerated behavior as compensation for lack of knowledge, Verbalization of erroneous information about the condition or treatment, Inaccurate execution of newly learned tasks, Assess patients current knowledge about the new diagnosis, Determine the patients manner of learning, Encourage the patient to participate in formulating treatment plans, Encourage the patient to ask questions when necessary or when in doubt, Facilitate conversations to be a learning-friendly discourse, Identify any possible obstacle that can impede the patients way of learning, If necessary or better, use other learning materials such as writing on paper, a demonstration, or a video, Teaching methods should pick up with the patients pace on learning, Instill a positive reinforcement to help the patient comply with the treatment plan, Assess the patients receptivity to new learning skills by having a simple and return demonstration related to the treatment plan, Providing a resource material to the patient regarding the treatment plan is helpful, Inquire the patient for possible feedback to assess the ongoing teaching method. In particular, the influence of different ethnic groups probably depends on the country/region since an ethnic minority in one region could be an ethnic majority in another region However, although ethnic minorities are different ethnic groups in different countries, we believe that all ethnic minorities likely face similar adherence challenges independent of the country they live in. Marital status was investigated in the SRs on Parkinson disease, inflammatory arthritis, chronic diseases, HIV, patients taking oral anticancer agents and cardiovascular conditions. 2012;73(5):691705. Unauthorized use of these marks is strictly prohibited. General comorbidity or physical comorbidity was assessed in inflammatory arthritis [38], patients taking oral anticancer agents, hepatitis C, chronic diseases and cardiovascular conditions [20, 21, 27, 28, 37, 39]. 2013;165(5):66578, 678.e1. 2011;86(4):30414. Review the patients surgery along with the performance of the procedure and the future expectations. Please enable it to take advantage of the complete set of features! Medical-surgical nursing: Concepts for interprofessional collaborative care. 7. Patients with low health literacy can have trouble maintaining a treatment plan and are more likely to end up back in the hospital. Intra-abdominal pressure contributes to GERD, so eating less food decreases intra-abdominal pressure. Note individual limitations.Developmental level, educational level, age, and language must be taken into account before providing written or verbal instructions. HHS Vulnerability Disclosure, Help In the final phase 3, the assessor judges whether the whole SRs is at risk of bias. volume8, Articlenumber:112 (2019) Drugs Aging. Bitton A, Choudhry NK, Matlin OS, Swanton K, Shrank WH. Proper bone healing takes a month, or even a year, if managed properly with appointments with physical therapists or physicians depending on the situation. For instance, internal fixation devices can ultimately affect the bones strength, while the intramedullary nails, rods, or plates may be removed once the physician recommended it after a long recovery. knowledge deficit related to medication compliance. 2007;14(4):40816. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/health-literacy, Impaired Physical Mobility Nursing Diagnosis & Care Plan, Chronic Pain Nursing Diagnosis & Care Plan, Unfamiliarity with subject (new diagnosis or treatment), Inaccurate demonstration or teach-back of instructions, Exhibiting aggression or irritability regarding teaching follow-up, Poor adherence or worsening medical condition, Avoiding eye contact or remaining silent during teaching, Patient will identify risk factors of their disease process and how to prevent worsening of symptoms, Patient will participate in the learning process, Patient will demonstrate the proper execution of, Patient will identify barriers to their learning and how to overcome. Educate the patient about enriching the diet with foods rich in iron, folic acid, and vitamin B12 as a remedy for those with nutritional deficiency anemia. In cardiovascular conditions, some evidence exists that a higher socioeconomic status has a positive impact on adherence [29]. Explain the significance of routine diagnostic procedures such as complete blood count (CBC), bone marrow aspiration, and a special consult to the hematologist once an anemia is noticed. The ROBIS tool is based on three phases. Mentz RJ, Greiner MA, Muntner P, Shimbo D, Sims M, Spruill TM, et al. This assumption is supported by the fact that especially therapy- and disease-related influencing factors, which are related to the symptomatic patients, were inconsistent. The patient needs to be involved in the decision-making process for treatment because factors such as medication dosage, pill burden, and regimen complexity influence adherence. Only negative effect directions were reported, but the evidence for a negative impact on adherence was uncertain in both conditions [38, 39]. Knowledge plays a vital role in the patients recovery and may include 3 domains namely: (1) cognitive domain, (2) affective domain, and (3) psychomotor domain. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams. Moreover, the results for many factors were inconsistent. The decision to exclude studies that were reported in this way was made because the results could have been highly biased by selective reporting otherwise. To heal properly, it is important to have the patient cooperate with any responsible clinical personnel in managing fracture. In addition, the evidence suggests that the influence of age on medication adherence has a concave pattern, i.e., lower adherence in young age groups, increasing adherence with a peak in middle to older age groups and lower adherence in very old age groups. The nurse must display cultural competency when educating patients. Repetition and reinforcement is a strategy that solidifies information. She found a passion in the ER and has stayed in this department for 30 years. Teaching is one of the most important interventions a nurse provides to patients. For instance, most people know anemia that is caused by iron deficiency only but unaware of the other types. Educate the patient regarding the anti-GERD medications and their potential side effects, and if such symptoms arise, notify the physician immediately. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. The process of study selection is illustrated in the PRISMA flowchart [41] (Fig. Sabate E. Adherence to long-therm therapies: evidence for action: Weltgesundheitsorganisation; 2003. In patients taking oral anticancer agents, there was some evidence that middle-aged people (approximately 4560) are more adherent than very old (>75years) and younger people (<45years) [28]. Evidence suggests that general mental comorbidity and belonging to an ethnic minority might have a negative impact on adherence and that a higher socioeconomic status might have a positive impact on adherence. Gourzoulidis G, Kourlaba G, Stafylas P, Giamouzis G, Parissis J, Maniadakis N. Association between copayment, medication adherence and outcomes in the management of patients with diabetes and heart failure. It was uncertain whether health insurance status (insured vs. uninsured) influences adherence in patients with chronic or cardiovascular conditions [23, 25]. Medication is the most frequent treatment intervention, and its success depends on patients taking their medicines in line with their prescribed regimen to yield the full benefit of the treatment. Grading of Recommendations, Assessment, Development and Evaluation, Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Our website services and content are for informational purposes only. Among patients with chronic diseases and patients taking oral anticancer agents, there was some evidence that a better financial status has a positive influence on adherence [20, 39]. Handbook of research synthesis and meta-analysis. ROBIS: a new tool to assess risk of bias in systematic reviews was developed. 2. Both reviewers agreed to exclude those SRs that reported only the number of statistically significant studies (e.g., 10 studies showed a statistically significant effect of gender) without reporting effect sizes and the total number of studies on a certain comparison (e.g., 12 studies analysed gender). Complications such as fever, urinary retention, nausea/vomiting, infections, etc., are dangerous so once they are detected, it is imperative to alert the physician responsible for the patients care.