Research Namin

8/6/2019 Research Namin

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COMPLIANCE OF THE ISABELASTATE UNIVERSITY STUDENTS

TO PHYSICIANS

PRESCRIPTION

Prepared by:Dugay, Ritchelle G.Flores, Angelie B.Lagmay, Ginger RoseQuidawen, Anamie S.


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Chapter I

THE PROBLEM AND ITS

BACKGROUND


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Health is one of the essential componentsof life. It encompasses the general well-beingof a person encompassing the physical,

emotional, mental, social, environmental,and spiritual aspect of his life. Impairment toone of these aspects of health may affect theother aspects, thus health preservation andpromotion is very important.


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Concerning about health of every individualespecially students is very important, in the factthat health is the foundation of every success.Sometimes, most students focus on their studies

not knowing that their health is affected. Insteadof buying medicines for them to relieve any painthey prioritize their needs in school. Even whenone recognizes personal susceptibility to such

illness, action will not occur unless theindividual perceives that the illness is becomingsevere.


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Most students take primary regimen such as

consulting to the school or university healthcareproviders at their infirmaries when they perceivethat something is wrong to their health.Howeverthere is no assurance whether they comply withthe Physicians prescription such as following the

right dose, time and duration of medications tobe taken. There are many potential explanationsfor why students dont take prescribed drugs,ranging from cost to convenience to the patients

not being totally convinced that the drug isnecessary to treat an asymptomatic condition asstated by Kenneth Lin,MD(http://www.kevinmd.com/blog/2010/06/patients-prescription-drugs.html).


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In another international study, Pauline Chen, ina recentNew York Timescolumn, discusses the

worrisome issue of medication noncompliance.According to the data, it was stated that asmany as half of all patients did not follow theirdoctors advice when it came to medications,and, more than 20 percent of first-time patientprescriptions were never filled.


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In addition, third world governments

have expanded the provision of primaryhealth services, and with it, the number ofprescriptions has increased phenomenally.However, little data were known about howthird world patients are using prescribedmedicines. In order to assess the availableinformation, 37 empirical studies were

reviewed on compliance to prescriptionslocated through electronic lines andnetworking.


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By and large, the orientation of the studies is

biomedical. The authors measure levels ofcompliance and advance recommendations toincrease them. It was found out that there islittle consistency in the definition of compliance

and a variety of methodologies used in itsmeasurement. In spite of methodologicalproblems, most researchers found low levels ofadherence to medical regimens. Low levels of

adherence raise questions about the quality ofcare, iatrogenic effects caused by the inadequateuse of modern medicines, and the health andeconomic impact of health investments.


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At the same tie it is recognized that, given

current prescribing practices and lack ofefficacy of many medicines, compliance mayadd little to the quality of care. Complianceand prescribing behaviors should always be

examined together and as part of quality ofcare assessments, as stated by NuriaHomedes and Antonio Ugalde in their studyon Patients' compliance with medical

treatments in the third world. What do weknow? as posted byhttp://www.heapol.oxfordjournals.org/content/8/4/291.abstract.


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Most College students visiting the

University or college infirmary or clinics arereceiving Physicians prescription mostlycontaining the drugs to be taken. Physiciansmay give free medications but may not cover

the complete days required for the drugs tobe taken. There may be no assuranceregarding the compliance of the students toPhysicians prescription. The health of a

person does not end from the time ofconsultation, it continues up to the how theclient follow the specific prescription oradvise.


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This research study will be conducted todetermine compliance of students of IsabelaState University to Physicians prescription.

Furthermore, the researchers of the studywould like to determine effect of the factorsnamely Financial, Social, cultural, religion,psychological and emotional factors) to

compliance of students to physiciansprescription.


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Background of the Study

The health care services of the IsabelaState University-Echague, Isabela started in a

small clinic located in the Administrationbuilding. It is a requirement for all theUniversities to have their own clinic as permemorandum ofCommission onHigher

Education (CHED) inorder to providehealthcare services to all the students anduniversity employees.


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The building of the infirmary started as amultipurpose building which was initiallyconstructed on September 6, 2004 throughthe priority development assistance fund of

Representative Ernesto C. Pablo, APECPartylist. It was completed by ISU during theadministration of Dr. Romeo R. Quilang,President to house the health Services of the

University System that was inaugurated lastJune 10, 2008.


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The university infirmary consists of theUniversity Physician who is the head, twonurses, and one dentist and one dental aid.


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As nursing students, we play a major role inhealth promotion and disease prevention. Theuniversity infirmary is one of the sources ofhealth of student of Isabela State University. It is

important to know if the student who haveconsulted infirmary have really complied withthe physicians prescription since healthimprovement does not only depends on the time

of consultation and interaction with the healthcare provider.Health of consumers will reallyimprove if they really complied with thePhysicians prescription.


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Thus, the researcher will conduct theresearch study to determine the compliance ifthe ISU students to the Physicians and the

factors affecting the students compliance.


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Objectives of the Study

Generally, the research study will be

conducted to determine the compliance ofthe Isabela State University students toDoctors prescription.


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Specifically, the research study aims todetermine the profile of the respondents, thefactors affecting the students compliance to

Doctors order, and the relationship betweenthe factors and the students compliance toPhysicians order.


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Statements of the Problem1. What is the profile of the respondents as to:

1.1. Age

1.2. Gender1.3. Course and Year1.4. Scholarships/Assistantships1.5. Religion1.6. Ethnicity1.7. Income of parents1.8. Occupation of parents1.9. Type of illness as diagnosed by theUniversity Physician


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2. What are the factors affecting the compliance toDoctors prescription relative to:

2.1. Financial

2.2. Social

2.3. Cultural

2.4. Spiritual

2.5.Mental

2.6. Emotional


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3. To what extent these factors affect thecompliance of the respondents to Doctorsprescriptions?

4. Is there a significant relationship betweenthe factors and the compliance of the

respondents?


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Significance of the Study

The research study is to be conducted todetermine the compliance of the Isabela State

University students to Physicians prescription.Since the ISU students are the respondents ofthe study, they are the ones that would be

benefited most in the sense that they will

become more aware regarding their health.Compliance to physicians prescription is one ofthe important components of health promotionand disease prevention.


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Parents of the respondents are the next tobe benefited after the respondents. Based onwhat will be the results of the study, parents

will become more aware on supporting theneeds of the students regarding health, andthis includes financial and social support.


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Aside from the respondents and theparents of the respondents, the Universityofficials and healthcare officials will also bebenefited. Depending on what will be the

results of the study, the University officialsand healthcare officials will become awareregarding the necessary modifications onpolicies regarding the healthcare services

offered by the University, inorder to promotebetter health among the students.


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Future researchers will also be benefited.They can conduct further evaluation on thisstudy. They can also conduct new studiesbasing on this study such a way that they can

apply the suggestion stated on literature ofthis study on the method of care given tostudents and evaluate the effectiveness of

these additional suggestions to compliance ofthe students to Physicians prescription


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Definition of Terms

The following words are the terms being used inthe study. The following words are defined

operationally.

Assistantships this is included in the profile ofthe respondents. This includes the scholarship

or financial supports that students receive formthe school or other sources.Compliance action made by students to follow

the Physicians prescription.


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C

ultural - relating to the arts and intellectualactivity and considered one factor that canaffect in complying Physician prescription

Ethnicity in the study it is included in theprofile of the students relating to ethnicaffiliation or distinctiveness

Financial one factor that can affect incomplying Physicians prescription thatpertains with money.


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Illness any alteration in health felt by thestudents that may trigger them to consult inthe infirmary

Infirmary - it is a primary source of healthcareof the students and employees in the IsabelaState University, Echague, Isabela.

A place were the students and employees wentfor the treatment their illnesses, it consists ofphysician, nurses, and dentist


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Spiritual one factor that can affect incomplying physician prescription relatingwith the quality or condition of beingspiritual and religious affiliation


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Scope and Delimitation

The scope of the study will be on determiningthe Compliance of Isabela State University

students to Physicians Prescription and thefactors affecting the Compliance of the students.

The study will be limited only to those

students of the Isabela State University who hadconsulted the University Infirmary within amonth for the first semester of school year 2011.


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Chapter II

REVIEW OF RELATED

LITERATURE


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Several studies have been taken for thesustenance of research study.

In one research regarding the Factors

Affecting Students' Medicine-Taking Habitsby C. E. Labig , K. Zantow, and T.O.Peterson, it was stated that the studyexamines college students' beliefs abouthealth, prescriptions, doctors, and theinfluence those beliefs have on adherence toprescribed medication regimens.


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After a brief review of attitudinal factorsthat influence adherence to prescriptionmedicine directions, the authors discussmeasurement issues and explain the reasons

for their approach to studying adherenceissues. The results of the exploratory studyindicate that college students' adherence to aprescribed medication regimen is more

strongly associated with beliefs about health,prescription drugs, and a self-cureorientation than students' satisfaction withtheir physicians.


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In the sample of students, forgetfulnessappears to be the dominant reason for non-adherence. One implication from theseresults is that adherence issues may be more

appropriately addressed in campuspromotions than in the medical clinic. Theauthors also offer suggestions for furtherresearch (Journal of American College

Health Volume 54, Number 3 / November-December 2006).


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PaulineC

hen, in a recentNew YorkTimescolumn, that there are many potentialexplanations for why patients dont followprescriptions such as taking the prescribed

drugs. She claimed that patients nonadherence with medication regimens remainsone of the most important healthcareconcerns; it is surprising that research in this

area is sorely lacking.


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Dr. Pauline Chen stated some multicausalphenomenon affecting the patients nonadherence to prescription which includes, theseriousness of illness, the cost of treatment,

the treatments side effects, the patients age,mental status and memory capacity thecomplexity of recommendation, the durationof regimen, the type of medical advice theclarity or unclarity of written instructionsand accessibility.


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Furthermore, Dr. Chen pointed out somepossible solutions on how to improve thepatients adherence to Physicians

prescription. She stated that one solutionwould be to have pharmacy in the Physiciansoffice where patients can pick up their

medications on the way out.


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She added that strategies for adherenceinclude raising information and skill levels,altering characteristics of the regimens and

improving the relationships between thehealthcare provider and the patient. Providerand patients awareness with regard tomedication adherence can be enhance with

the creative application of the behavioralcontracts thus Improving reinforcement.


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Zasstocki and Rovinski-Wagner added

suggestions on how to take medications properlyto solve the problem of medication nonadherence. Stated below are the followingsuggestions:

TO TAKEMEDICATION PROPERLY

Be sure you understand

Each medications nameWhy you are taking the medication

How much medication you should take


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How to take the medication:

-With meals or on an empty stomach

-The same time each day

-The number of hours between doses

The side effects

The side effects (symptoms) you should report to

your nurse or doctor


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Always ask your nurse or doctor about any

questions you have

Take your medications exactly as instructed

-Do not take anyone elses medications

-Do not take medications you can buywithout prescriptions (over the counter) unlessthey are approved by your nurse or doctor

-Do not use alternative medicine or herbal orvitamin supplements unless they are approvedby your nurse or doctor.


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Follow any special safety precautions, such as

-Keep your medications separate from otherfamily members medications.

Let your family and friends to help you

Ask your nurse or doctor about communitygroups that maybe able to help you.

Your nurse can help you with-Fitting your medication into your daily

routine. Try to keep your routine as simple aspossible


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Tips to help you remember to take your

medication, such as-Using a calendar, grease board, or checklist

with the medication times marked.

-Using an egg carton to arrange medicationfor the day

-Scheduling your medications around usualroutine such as meals

-Using pictures or colored dots on bottles.For example red dots or a picture of a sun willtell you to take the medication in the morning


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-Using an index card with a picture of the

medication by your toothbrush could remindyou to take medication in the morning or inbedtime

-Using a medication organizer on the nextpage for example

(H

OM

EC

ARE; Patients and Family Instructions;Second Edition; Page 23)


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In addition, in order that medication can

achieve its intended benefit it is importantthat people complete the prescribed course orcontinue to take it when a chronic conditionis present. Compliance refers to the extent towhich people follow health advice or otherprescribed regimens, including drugtreatment. It may assume that most people

comply with prescribed drug treatment;however, this is often not the case and thereare many reasons or for this, includingpolypharmacy and difficulty in:


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Understanding why medication is necessary

Understanding what benefits what themedication may have

Remembering advice given to themAccepting disruption to their lives

Accepting that they have condition that requirestreatment


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Potter and Perry emphasized that patients

mentality is a factors associated with compliance toPhysicians prescription especially in terms ofmedication adherence. Client knowledge about aprescribed medication varies with the person and

depends on many factors. Some clients desire andreceive detailed information about the medicationsthey are taking, whereas other clients want andreceive minimal information. Determine what the

client already knows and what he or she needs toknow to take medication safely. Then ask questions toelicit this information. Clearly document inadequateknowledge or gaps in important areas so that an

individualized teaching plan can be formulated.


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Assessing cognitive ability is important

for individualizing the teaching plan anddetermining whether the client canindependently manage self-medication.Cognitive impairment, confusion, and

psychiatric disorders may increase thepotential for difficulty with the medicationregimen. Learning disabilities may

necessitate creative teaching to ensureunderstanding and compliance with therapy.Include family members or the caregiver inthe teaching sessions.


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Compliance with a medication routine

means, that the client takes the medicationexactly as prescribed. Lack of compliance canoccur in many ways, for example when client:

does not take any of the prescribed drug;

does not take the proper number of doses ofthe drug;

takes extra doses of the drug; does not follow the dosage schedule as

prescribed;


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discontinues the medication, prematurely;

excessively uses a PRN order; Takes medication that was ordered previously

for another condition.

Clients are more likely to follow simplemedication routines that suite their lifestyles. Aclients attitude, about medical care and aboutspecific medications can influence his/hercompliance with drug therapy. Begin by askinggeneral questions, such as, Do you believe thatthis medication will help you get better? Bealert to comments that indicate a clients lack ofconfidence in prescribed drug treatment.


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Lifestyle and financial considerations alsoaffect the compliance with drug therapy. Theclient with a regular income, healthinsurance, and a stable home is more likely toobtain medications and to organize routinesto remember to take them. when a client doesnot have in a home, income, or health

insurance, buying, storing, and rememberingto take medications regularly can be difficult.


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Compliance is a clients adherence to the

prescribed course of therapy. Unfortunately notall persons are interested in maintaining health.Many people will not adopt new health

behaviors unless they perceive a disease as a

threat, they overcome barriers to changinghealth practices, and they see the benefits toadopting a healthy behavior. The nurse assessthe clients motivation to learn and what the

client needs to know in order to promotecompliance with the prescribed therapy(Fundamentals of nursing; seventh edition,2009).


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Taylor, Lillis, and LeMone added thatnurses play a great role for the compliance ofpatients. Nursing assessment of the patientslearning needs is vital to developing a plan ofcare in with which the patient can comply.Patients are considered compliant when theyfollow the treatment plan and use the

information they have been taught.


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Noncompliance occurs when patients ignore

instructions or do not follow themapproximately. Noncompliance can also beassociated with a lack of learning readiness andmotivation, confusion, disappointment,

misunderstanding, fear, inability to learn, orinadequately finances. When patientsunderstands their diagnosis, treatmentrationale, medication regimen and the benefitsof compliance, they are more likely to comply.

Noncompliance can hurt the patients health.Increased patients compliance is direct outcomeof effective patients teaching (Fundamentals ofnursing, Chapter 22, page 483).


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In another study made by Steve Wilkins

that factors affecting patients compliance arecategorized into two groups namely: factorscan be categorized into two groups:Unintentional non-adherence andIntentional non-adherence.

Unintentional non-adherence is related to

a patients ability and resources to take theirmedication (e.g., problems with manualdexterity, forgetfulness, inability to pay formedication, etc.).


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Intentional non-adherence is associated with

a patients motivation and beliefs, e.g., thereasons for needing a medication, the efficacy ofa proposed treatment and concerns about sideeffects of medication or treatment

(http://www.kevinmd.com).

Patients who do not take the medications asprescribed or who do not recognize warningsigns of illness exacerbation or drug side effectsare at risk for unsuccessful results, adversereactions, and poor quality of life. (Schatzberg etal, 2007).


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The threats to patient adherence are

many. Some of them come from the mentalhealth team, others from the patient orfamily, and still others reflect a shared failureof the therapeutic alliance. Nurses, patients,and families should work together tominimize misunderstandings andunnecessarily complex medication regimen

(Kozuki et al, 2005; Tay 2007). Too oftenclinicians blame patients for non-adherencewithout completing the following:


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Fully evaluating the treatment plan from thepatients perspective

Aligning the treatment plan with the patients

goals (rather than the clinicians goals) Designing the treatment plan based on all

aspects of the patients life, rather thanmerely the reduction of symptoms

Understanding the patients reasons for non-adherence


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Synthesis of the Study

In the review of related literatures severalstudies were taken for the sustenance of researchstudy.

The different studies that were included in

the review of related literatures, all pointed outto the factors affecting the compliance ofpatients (students) to Physicians prescriptionespecially in terms of medication adherence,


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these factors include the seriousness of illness,the cost of treatment, the treatments sideeffects, the patients age, mental status andmemory capacity the complexity ofrecommendation, the duration of regimen, the

type of medical advice the clarity or unclarity ofwritten instructions and accessibility. Insimilarity with the research study, researchersalso pointed out several factors that may affect

the compliance of Isabela state Universitystudents to Physicians prescription, whichincludes the financial, social, mental, spiritual,cultural, and emotional factors.


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On the other hand, the researchers have

seen two differences between research studyand studies included in the review of relatedliteratures. First is that, the researchers wantto determine as to what extent does the factoraffects the compliance of Isabela stateUniversity students to Physicians prescription.Second, the studies on the review of related

literature include suggestions on how toimprove the compliance of patients toPhysicians prescription which is not includedin the research study.


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Conceptual Framework

This study seeks to ascertain factorsaffecting the students compliance to

Physicians prescription. Another inspirationbehind all of these efforts is to determine iftheres really a significant relationship

between the factors affecting and thestudents compliance to Physiciansprescription.


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The summarization of the research to be

conducted is shown in Figure 1 underconceptual paradigm. The relative factorsinclude financial, social, cultural, spiritual,

mental and emotional, while the profile ofthe respondents include age, gender, courseand year, scholarships/assistantships,religion, ethnicity, income of parents,

occupation of parents and type of illness asdiagnosed by the University Physician.


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Every shape used in conceptual paradigm

has significance in order for the researcher tohave pattern and basis in the study. Boxes indifferent sizes represent as an enclosingshape of the following: profile of the

respondents, relative factors, compliance ofthe respondents to Physicians prescriptionsand significance of the relationship of the

three. Lines help to connect each of theenclosed words.


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The one with the emphasized box is the

compliance to Physicians prescription. Theresearcher made it to be emphasized since itwill be the focus of the study, in which theprofile of the respondents themselves andrelative factors are connected to. This is togive a clue in part of the researcher to befocusing on, if the factors have really effect

on students compliance to Physiciansprescription and its extent of influencetoward the compliance to Physiciansprescription.


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The lines connected from the profile ofthe respondents, relative factors andcompliance to Physicians prescription are

then again connected to significance of therelationship back to the profile of therespondents, pointing toward relationshipor interrelatedness.


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PROFILE OF THE

RESPONDENTS

-Age

-Gender-Course and Year

-Scholarships/Assistantships

-Religion

-Ethnicity

-Income of parents

-Occupation of parents

-Type of illness as diagnosedby the

University Physician

R E L A T I V E F A C T O R S

EmotionalPsychological

Financial Social Spirituality Cultural

C O M P L I A N C E T O P H Y S I C I A N S P R E S C R I P T I O N

SIGNIFICANCE OF THE

RELATIONSHIP

Figure 1


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Chapter III

METHODOLOGY


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Research Design/Method

The researcher will use the descriptivecorrelational design. Descriptive Research

design is a valid method for researchingspecific subjects. The purpose of Descriptivestudies is to observe, describe, and documentaspects of a situation as it naturally occurs and

sometimes to serve as a starting point forhypothesis generation or theory development.(Nursing research; eight edition by D. Polit andC. Beck, 2008.)


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Data Gathering Instrument

The data gathering instrument to be used forthe research study will be a questionnaire

regarding the demographic profile of therespondents namely Age, Gender, Course and

Year, Scholarships/Assistantships, Religion,Ethnicity, Income of parents, Occupation ofparents, and Type of illness as diagnosed by theUniversity Physician and the factors affectingtheir compliance to Physicians prescription.


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The questionnaires are used to determine as to

what extent does the factors affect thecompliance of the respondents. Thequestionnaires will be floated among therespondents. The Likert Scale is use in the

questionnaire and the questions included areclose ended questions and are answerable bymeans of putting a mark in degrees of numbers

with interpretations. These degrees of numbers

are 5 (strongly agree), 4 (moderately agree), 3(undecided), 2 (disagree), and 1 (stronglydisagree).


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To come up with qualitative results, aninterview with the respondents will beconducted. An interview guide will be use for

the interview. The response of therespondents to the questions in the interviewwill be group depending on theinterrelatedness of their answers.


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Data Gathering Procedure

Step 1.

The researchers will go to the Universityinfirmary to get the list of names of thestudents who consulted the infirmary on a

weekly basis within a period of one month inthe first semester School year 2011.


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Step 2.

After getting the list of names of thestudents who consulted the infirmary, theresearcher will ask consent from the student.If the student granted the consent, he/shewill be the respondent of the study. However,if the respondent refused to grant the

consent, he/she has the right and this will berespected by the researchers.


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Step 3.

The researchers will conduct a follow upinterview with the respondents (the ISU

students who consulted the Universityinfirmary within a month. A follow-upinterview will be conducted with therespondents, and an interview guide will be

use during the interview. The interview guideconsists of questions regarding thecompliance of the students to Physiciansprescription.


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Before the questionnaires are floated among

the respondents, a Pilot testing will be done firstin which the researchers will do pre-testing ofquestionnaires to some of the respondents. Toaccomplish the Pilot testing, the researchers will

get some of the respondents (but not all) and letthem answer the questions in the questionnaire.The Pilot testing is done to determine the

validity of questionnaires. Those students whoanswered the questions during the Pilot testing

will not be included anymore as respondents ofthe study. If the questionnaires are valid afterthe Pilot testing, the researchers will float thequestionnaires among all the respondents.


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But, if after the Pilot testing, there aresome questions that should be modified, theresearchers will modify specific questionsbefore floating the questionnaires to all the

respondents. This is done to ensure that therespondents will not encounter difficulty inanswering or understanding the questions.


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Step 5.

After the interview with the respondentsand after floating the questionnaires among

the respondents, the researchers will beginanalyzing and interpreting data.

Regarding the interview, the answers of

the respondents will be group according tosimilarity or interrelatedness of theiranswers.


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Regarding the questionnaires, specific

statistical tools will be used to group theprofile of the respondents and to determineas to what extent does the factor affect the

compliance to physicians prescription.

The data will be organized, tabulated andtallied. The researchers will get the

percentage, mean, frequency of the data.


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A percentage and frequency distribution

will be used in analyzing the data regardingthe profile of the respondents. In terms ofanalyzing the data on the questionnaire

regarding the different factors included, themean of the response of the respondents willbe use to analyze the data.


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Chapter IV

RESULTS AND

DISCUSSION


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Table 1. Frequency and Percentagedistribution of Respondents according totheir personal background

Table 2.Mean Distribution of the Factorsaffecting the Compliance of Isabela StateUniversity students to Physicians

Prescription


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R

eference List

Fundamentals of Nursing,HumanHealth andFunction Fifth Edition by: Ruth F. Craren,

ConcstanceHirnle; Chapter 29 (); Pages 561-562.

Fundamentals of Nursing Practice, FundamentalsofHolistic Care foreword by Roger Watson,

Edited byChris Broocker and Anne Waugh;Chapter 22 Promoting the Safe Administrationof Medicines by Christine Burton and Jayne

Donaldson; Page 648.


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HOMECARE; Patients and Family Instructions:

Second Edition; Page 23

Journal of American CollegeHealth; Volume 54,Number 3/November-December 2006

D. Polit and C. Beck. Nursing research; eightedition, 2008.

http://www.kevinmd.com/blog/2010/06/patients-prescription-drugs.html

http://www.heapol.oxfordjournals.org/content/8/4/291. abstract


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Let your Light shines, and be aSalt that makes a difference


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Thank You

GOD BLESS

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