LECT 13PROMOTING HEALTH AND ENHANCING TREATMENT.ppt

School research

1. PROMOTING HEALTH
AND ENHANCING
TREATMENT

2. ADDICTION AND DEPENDENCY
Drug misuse- use of drug other than what it is
intended for
Drug abuse- use of a drug in a dangerous or
harmful way
Drug addiction- use of a drug in a highly
frequent and obsessive manner, with
withdrawal symptoms when use ceases

3. Problem drug usage- any use of drug which
causes problems to the users or those
around them

4. Situation needing special attention
Obstetrics
Surgery
General practice
Internal med
Infectious disease
Causality
MTCT
May show high
tolerance to
anesthetics, may be
HIV positive
May be deceptive and
disruptive
May fake
HIV, hepatitis
Overdose, injuries,
accident, violence

5. Psychoactive drugs commonly abused
Sedatives- barbiturates,
Stimulants- amphetamine, cocaine
Narcotics- opium, heroin, morphine
Psychedelics & hallucinogens - cannabis,
marijuana, LSD
Anti anxiety drugs- valium, compoz
(minor tranquilizers)

6. Alcohol
Most commonly used recreational drug
Most users come to no harm, but can cause
medical, psychological and social problems

7. Alcoholism –alcohol dependence
Symptoms
Craving
Loss of control
Physical dependence
Tolerance

8. Considered to be a chronic illness
Life span of alcoholics- average 12 years
shorter
Leading cause for CHD and cancer
Suicide rates and attempts high

9. Clinical picture
Depressant that affects higher brain centers
Impairs judgment and other rational process,
lowers self control
Motor incoordination
Perception of pain, cold and other discomfort
dulled
When alcohol level in blood reaches 0.1%
intoxicated

10. Thought process confused
May build tolerance
May experience blackouts
May experience hangover

11. Early warning signs of alcohol
dependence
Frequent desire to drink
Increased consumption
Extreme behaviour
Blackouts
Morning drinking
Loss of control
Continuous drinking
Alcohol dependence reached when
withdrawal symptoms develop

12. Medical problems
High calorie
Liver damage
CHD
Hypertension
Risk for stroke
Cancer
Neurological disease- Korsakoff’s syndrome
Fetal Alcohol syndrome

13. Chronic illness
Differ from acute illness:
Have multiple causes including life style
Have slow onset
Cannot be cured, only managed

14. Consequences of chronic illness
Physical problems
Depends on illness
Burden of treatment
Body image
Difficulty in managing daily tasks
Side effects of medication

15. Social problems
Stigma
Interpersonal relationship
Work
Study
Limitations on taking part in social activities

16. Psychological problems
Initial shock and disbelief
May have to put aside plans and dreams
Disbelief, denial, anger, anxiety
Depression
Guilt
Threat to independence

17. Coping with chronic illness
ILLNESS DIAGNOSIS
PRIMARY APPRAISAL
THREAT POSITIVE- No coping action
STRESS
SECONDARY APPRAISAL
(coping)
Seek
information
Take direct
action
Do
nothing
worry

18. Strategies for coping with illness
Normalising
Acknowledge symptoms but redefine it as a
part of normal experience
Neutralise the threat
Sometimes cause problem in clinical
management

19. Denial
Denies existence of the illness
May be useful in early stage
If deny for long, prevents individual from
confronting the illness
Considerable effect on treatment and family

20. Avoidance
Do not deny the problem but avoids situations
which may exacerbate the symptoms or lead
to other problems
Can be maladaptive

21. Resignation
Person totally embraced in their illness
Resign themselves to their fate
Illness is defined in ways to get rewards
Doesn’t take control over their life
May become dependent on others

22. Accomodation
Acknowledges and deals with the problems
related to the illness
Goes on with life without fuss
Don’t become dependent
Comply with treatment

23. Compliance
This is when patients adhere to the medical
plan

24. Predicting compliance
PATIENT
SATISFACTION
COMPLIANCE
understanding
memory

25. Patient satisfaction –from :
Consultation- particularly affective
componenet
Competence- referral, diagnosis
Behaviour- explaining, greeting
Content of consultation-
If satisfied results in improved interest,
understanding, consultation becomes friendly
and pleasant and can result in joint
negotiated decision

26. Patient understanding-
Understand content of consultation
Understand advise given and the importance
of it
Understand treatment plan

27. Memory- patient recall
Must recall drug, dosage, duration
Influenced by previous knowledge,
intellectual level, anxiety

28. Improving compliance
Promoting patient satisfaction
Doctor must be interested in what the patient
is saying
Satisfaction depends on patients perception
of doctors sensitivity, concern, respect and
competence
Reducing waiting time, greeting, establishing
rapport, open-ended questions

29. Increasing comprehension
Use simple language
Finding out what the patient knows and
expects
Encouraging, supporting
Giving information
Individualised instructions improves
compliance by 70% (Haynes 1982)

30. Role of information in improving
compliance
Oral information
Primacy and recency effect
Stress importance of compliance
Simplify information
Use repetition
Be specific
Follow up
Elicit attention
Encourage patient to take notes
Provide printed information

31. Written information
Written information about medication
increased knowledge by 90% and adherence
by 60%

32. Adherence model
Stanton (1987)
Depart from the traditional view of a doctor
as an expert who gives advise to a compliant
patient
Model suggests that COMMUNICATION from
health practitioner results in enhanced
patient knowledge , patient satisfaction and
adherence to recommended treatment regime
Patient beliefs also determine adherence
(HBM)

33. Jones et al (1987) used HBM to increase
adherence among patients attending clinic
with asthma symptoms. Patients received
information about susceptibility, seriousness
of complication and benefits of seeking
treatment. 91% came for follow-up (vs 43%),
75% kept appointment (vs 10%)