1
|
Reach G. How is Patient Adherence Possible? A Novel Mechanistic Model of Adherence Based on Humanities. Patient Prefer Adherence 2023; 17:1705-1720. [PMID: 37484740 PMCID: PMC10362896 DOI: 10.2147/ppa.s419277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Patient non-adherence is a major contemporary medical issue because of its consequences in terms of frequency, morbidity and mortality, and health care costs. This article aims to propose a mechanistic model of adherence based on the tenet that non-adherence is the default option, as long-term adherence in chronic diseases requires sustained effort. The real question becomes, how is patient adherence possible? By focusing on adherent patients, the paper explains the mental mechanisms of adherence using concepts largely drawn from humanities, philosophy of mind, and behavioral economics and presents the findings of empirical studies supporting these hypotheses. The analysis first demonstrates the relationship between patient adherence and temporality and the influence of character traits. Further, it points out the importance of habit, which allows adherence to become non-intentional, thereby sparing patients' cognitive efforts. Finally, it points out the importance of the quality of the interaction between the person with a chronic disease and the health professional. These features explain why adherence is a syndrome (the healthy adherer phenotype), separating people into those who are safe and those who are at risk of non-adherence, non-control of diabetes, and complications. The concepts presented in this article summarize 20 years of personal clinical and philosophical reflection on patient adherence. They are mainly illustrated by examples from diabetes care but can be applied to all chronic diseases. This novel model of adherence has major practical and ethical implications, explaining the importance of patient education and shared medical decision-making in chronic disease management.
Collapse
Affiliation(s)
- Gérard Reach
- Education and Health Promotion Laboratory, Sorbonne Paris Nord University, Bobigny, Île-de-France, 93000, France
| |
Collapse
|
2
|
Buczkowska M, Górski M, Domagalska J, Buczkowski K, Nowak P. Type D Personality and Health Behaviors in People Living with Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14650. [PMID: 36429364 PMCID: PMC9690440 DOI: 10.3390/ijerph192214650] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/31/2022] [Accepted: 11/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Considering that health behaviors and personality traits play an important role in the formation of health attitudes, the main objective of this study was to evaluate the relations that occur between type D personality and health behaviors in a group of obese patients. METHODS 443 adult patients with BMI ≥ 30 kg/m2, who had been hospitalized in selected hospital facilities in the Silesian Voivodeship (Poland), participated in the study. Respondents completed three standardized questionnaires-the Multidimensional Health Locus of Control Scale, version A (MHLC-A), the Inventory of Health Behaviors (IZZ), and the Type D Scale (DS-14). RESULTS Patients with type D personality were characterized by the least effective mental attitudes and preventive behaviors, and differed significantly from the other personality types (intermediate and non-type D). Type D personality increased the risk of initiating improper health behaviors by more than five times. Regarding the sense of health control, patients with type D personality had significantly lower scores for the Internal Dimension subscale (21.3 ± 3.1) and higher for the Powerful Others Dimension subscale (24.0 ± 2.6), compared to patients with intermediate and non-type D personality. Proper health behaviors correlated with an internal sense of health control; the strongest correlation, defined as a medium, was with Preventive Behaviors (R = 0.42; p < 0.0001). CONCLUSIONS Type D personality was associated with poorer attitudes towards health. Among obese respondents with a type D personality, there was a significantly higher prevalence of those who believed that their health status was a consequence of chance events.
Collapse
Affiliation(s)
- Marta Buczkowska
- Department of Toxicology and Health Protection, Faculty of Health Sciences in Bytom, Medical University of Silesia, 41-902 Katowice, Poland
| | - Michał Górski
- Doctoral School of the Medical University of Silesia in Katowice, Faculty of Health Sciences in Bytom, Medical University of Silesia, 40-055 Katowice, Poland
| | - Joanna Domagalska
- Department of Environmental Health, Faculty of Health Sciences in Bytom, Medical University of Silesia, 41-902 Katowice, Poland
| | - Krzysztof Buczkowski
- Department of General and Oncological Surgery, City Hospital, 41-100 Siemianowice Slaskie, Poland
| | - Przemysław Nowak
- Department of Pharmacology, Faculty of Medicine, University of Opole, 45-052 Opole, Poland
| |
Collapse
|
3
|
Reach G, Benarbia L, Benhamou PY, Delemer B, Dubois S, Gouet D, Guerci B, Jeandidier N, Lachgar K, Le Pape G, Leroy R, Masgnaux JH, Raclet P, Reznik Y, Riveline JP, Schaepelynck P, Vambergue A, Vergès B. An Unsafe/Safe Typology in People with Type 2 Diabetes: Bridging Patients' Expectations, Personality Traits, Medication Adherence, and Clinical Outcomes. Patient Prefer Adherence 2022; 16:1333-1350. [PMID: 35642243 PMCID: PMC9148599 DOI: 10.2147/ppa.s365398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Support programs are provided to people with diabetes to help them manage their disease. However, adherence to and persistence in support programs are often low, making it difficult to demonstrate their effectiveness. AIM To identify the determinants of patients' perceived interest in diabetes support programs because it may be a powerful determinant of effective participation in such programs. PATIENTS AND METHODS An online study conducted in April 2021 in metropolitan France on 600 people with diabetes recruited from a consumer panel. A 64-item psychosocial questionnaire including a question asking to evaluate the helpfulness of a support program was used. Univariate, multivariate, and multiple correspondence analyses were performed. RESULTS The existence of a typology, known as Unsafe/Safe, was discovered, in which patients with type 2 diabetes respond in two distinct ways. Type U (unsafe) patients, who believe that a support program would be helpful, are more likely to be nonadherent to their treatment, have high hemoglobin A1c levels, have at least one diabetic complication, lack information regarding their disease and treatment, rate the burden of their disease and impairment of their quality of life as high, worry about their future, and are pessimistic. Type S (safe) patients have the opposite characteristics. Type U patients can be dichotomized into two broad classes: one in which they lack information regarding disease and treatment and the other in which alterations in the quality of life and burden of the disease predominate. Insulin-treated patients give more importance to the lack of information, whereas noninsulin-treated patients complain primarily about the burden of the disease and impairment of quality of life. CONCLUSION This study describes this new U/S typology, proposes a simple method based on a nine-item questionnaire to identify type U patients by calculating a Program Helpfulness Score described herein, and clarifies the nature of the intervention to be provided to them. This novel approach could be applied to other chronic diseases.
Collapse
Affiliation(s)
- Gérard Reach
- Health Education and Promotion Laboratory (LEPS EA 3412), Sorbonne Paris Nord University, Bobigny, France
- Correspondence: Gérard Reach, Health Education and Promotion Laboratory (LEPS EA 3412), Sorbonne Paris Nord University, 74 Rue Marcel Cachin, Bobigny Cedex, 93017, France, Tel + 33 (0)6 60 84 53 25, Email
| | | | - Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital; Grenoble Alpes University, INSERM U1055, LBFA, Grenoble, France
| | - Brigitte Delemer
- Service d’Endocrinologie – Diabète – Nutrition, CHU de Reims - Hôpital Robert Debré, and Université de Reims Champagne Ardenne, UFR Sciences Exactes Et Naturelles, Reims, France
| | - Séverine Dubois
- Department of Diabetology and Endocrinology, CHU Angers, Angers, France
| | - Didier Gouet
- Department of Diabetology and Endocrinology, Saint Louis Hospital, La Rochelle, France
| | - Bruno Guerci
- Department of Endocrinology, Diabetology and Nutrition, CHRU of Nancy, Brabois Hospital, and ILCV Lorraine University, Vandoeuvre-les-Nancy, France
| | - Nathalie Jeandidier
- Department of Endocrinology, Diabetes and Nutrition, Hôpitaux Universitaires de Strasbourg, and Université de Strasbourg, Strasbourg, France
| | - Karim Lachgar
- Department of Diabetology and Endocrinology, Centre Hospitalier Simone Veil, Eaubonne, France
| | | | - Rémy Leroy
- Private Medical Practice, Endocrinology and Diabetology, Lille, France
| | | | - Philippe Raclet
- Association Française des Diabétiques de Bourgogne Franche-Comté, Dijon, France
| | - Yves Reznik
- Department oEndocrinology and Diabetology, CHU Côte de Nacre, Caen, and University of Caen Basse-Normandie, Medical School, Caen, France
| | - Jean-Pierre Riveline
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Université de Paris, Paris, France
| | - Pauline Schaepelynck
- Department of Nutrition-Endocrinology-Metabolic Diseases, Pôle ENDO, APHM-Hôpital la Conception, Marseille, France
| | - Anne Vambergue
- Department of Diabetology, Endocrinology, Metabolism and Nutrition, CHU Lille, and University Hospital European Genomic Institute for Diabetes, Lille, France
| | - Bruno Vergès
- Department of Endocrinology-Diabetology,CHU Dijon, and University of Burgundy, INSERM LNC UMR1231, Dijon, France
| |
Collapse
|
4
|
Benis A, Banker M, Pinkasovich D, Kirin M, Yoshai BE, Benchoam-Ravid R, Ashkenazi S, Seidmann A. Reasons for Utilizing Telemedicine during and after the COVID-19 Pandemic: An Internet-Based International Study. J Clin Med 2021; 10:jcm10235519. [PMID: 34884221 PMCID: PMC8658517 DOI: 10.3390/jcm10235519] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic challenges healthcare services. Concomitantly, this pandemic had a stimulating effect on technological expansions related to telehealth and telemedicine. We sought to elucidate the principal patients' reasons for using telemedicine during the COVID-19 pandemic and the propensity to use it thereafter. Our primary objective was to identify the reasons of the survey participants' disparate attitudes toward the use of telemedicine. We performed an online, multilingual 30-question survey for 14 days during March-April 2021, focusing on the perception and usage of telemedicine and their intent to use it after the pandemic. We analyzed the data to identify the attributes influencing the intent to use telemedicine and built decision trees to highlight the most important related variables. We examined 473 answers: 272 from Israel, 87 from Uruguay, and 114 worldwide. Most participants were women (64.6%), married (63.8%) with 1-2 children (52.9%), and living in urban areas (84.6%). Only a third of the participants intended to continue using telemedicine after the COVID-19 pandemic. Our main findings are that an expected substitution effect, technical proficiency, reduced queueing times, and peer experience are the four major factors in the overall adoption of telemedicine. Specifically, (1) for most participants, the major factor influencing their telemedicine usage is the implicit expectation that such a visit will be a full substitute for an in-person appointment; (2) another factor affecting telemedicine usage by patients is their overall technical proficiency and comfort level in the use of common web-based tools, such as social media, while seeking relevant medical information; (3) time saving as telemedicine can allow for asynchronous communications, thereby reducing physical travel and queuing times at the clinic; and finally (4) some participants have also indicated that telemedicine seems more attractive to them after watching family and friends (peer experience) use it successfully.
Collapse
Affiliation(s)
- Arriel Benis
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel; (M.B.); (D.P.); (M.K.); (B.-e.Y.)
- Faculty of Digital Technologies in Medicine, Holon Institute of Technology, Holon 5810201, Israel
- Correspondence:
| | - Maxim Banker
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel; (M.B.); (D.P.); (M.K.); (B.-e.Y.)
| | - David Pinkasovich
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel; (M.B.); (D.P.); (M.K.); (B.-e.Y.)
| | - Mark Kirin
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel; (M.B.); (D.P.); (M.K.); (B.-e.Y.)
| | - Bat-el Yoshai
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel; (M.B.); (D.P.); (M.K.); (B.-e.Y.)
| | | | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel 4070000, Israel;
| | - Abraham Seidmann
- Department of Information Systems, Questrom Business School, Boston University, Boston, MA 02215, USA;
- Health Analytics and Digital Health, Digital Business Institute, Boston University, Boston, MA 02215, USA
| |
Collapse
|