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Patient Uncompliance in Diabetes Prof. Morsi Arab

Patient Uncompliance in Diabetes Prof. Morsi Arab.

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Patient Uncompliance in Diabetes Prof. Morsi Arab

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  1. Patient Uncompliance in DiabetesProf. Morsi Arab

  2. Definition: comply= agree/ yieldConsequences : 1- immediate conseq. can be serious ; eg. Ketoacidocis , hypoglycaemia ,etc. 2- Unachievement or loss of Control levels (glycaemic, BMI, lipids, B.P., etc) 3- Development or acceleration of complications.Epidemiology : *a current national study. *Prevalence - Types and grades -- Risk factors- Correlations with consequences

  3. Types and Fields of uncompliance : (simple or combinations)I- In Medication:(insulin,oral & complementary) - total stop ( of one or more medicines) - diminish or exceed dose (or number of injections). - change type (e.g. mixed insulin instead of NPH) - interrupted treatment.

  4. II- In Dieting - unrestricted (exceed total intake) - errors in caloric distribution , number of meals snacks, skip meals, irregular timing ,etc. - Type: Over- intake of Fat , Sugar, etc (salt)

  5. III- In Exercise: basal – working – sports . IV- In Other Behaviours: ( smoking--alcohol –drugs addictions-- contraindicated medications (eg. Steroids ).

  6. Grades of Uncompliance : - Minor and major - Continuous or interrupted - Single or multiple aspects

  7. Diagnostic Approach to Uncompliance A- Patient Factors : 1- Psychological state after recent discovery of diabetes ( at stages of denial , revolt , despair ….) 2- Having wrong concepts and belief ( health locus , cause of illness , distorted information about diabetes.) 3- Nonspecific totalitarian lovers of opposing stand. 4- Slaves of their habits ( e.g. smoking , diet, exercise ) 5- Transient depression from failing to achieve goals . 6- Transient stress : social , economic , inter-current illness.

  8. B- Inadequate Education at Management I- unclear objectives Knowledge :,unsuitable to type and stage of diabetes ,wrong priorities. Skills : psychomotor , communication and cognitive . Attitudes and Behaviors. II- Inadequate methods : (a) In providing knowledge : - Too much , or unsuitable content in a presentation. - Poor performance at the one-to-one education ( listen, motivate, encourage, etc. ). - In small group education: ( ignorance of group dynamics ) - In large group presentation: ( Inability to ensure active participation of audience.) - In mass media education: (inducing panic and confusion). - Inadequate use of AV- aids ,and education facilities .

  9. ( b) In teaching skills, inadequate description--demonstration and exercise . (c) Neglect of attitudes changes through model inspiration (good & bad) , contacts , discussions. etc. III- Absence of follow-up evaluation: - pre and post testing - follow up records of control parameters and compliance - check lists of performance of skills - rating scales for attitude changes

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