Culturally competent care – the essence of good service user experience
April 6, 2022
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The importance of treatment adherence and compliance

World Health Organization (WHO)describes chronic medical conditions as: “Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, are caused by non-reversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation or care”. In recent times, we see many people living with various chronic diseases that place different types of demands on the individual. One may be treated using medications, surgery, therapies and various others either simultaneously or sequentially. Furthermore, they may be required to make lifestyle changes such as diet and exercise. Following the advice and adhering to prescriptions, recommendations and guidelines for a short/long period or even for the rest of their lives can be challenging. This requires a lot of support and motivation.

We may often hear the terms treatment adherence and compliance a lot. Although both of these terms are used interchangeably, they do not mean the same. Understanding their meanings can be an eye opener for both healthcare providers and service users (De las Cuevas, C., 2011). Adherence is defined as “the extent to which a person’s behaviour, taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider” (Chakrabarti, S., 2014). Whereas compliance is defined as “the extent to which the patient’s behaviour matches the prescriber’s recommendations” (Chakrabarti, S., 2014). Both of these are extremely important to achieve better health outcomes in patients or service users. If the health needs are complex and challenging, it is even more important to understand treatment adherence and compliance to achieve better health outcomes to improve the quality of life and alleviate stress among service-users.

Taking medications and following treatment advice may not only be dependent on the physical needs of the individuals but also on various other aspects such as the psycho-social and spiritual aspects. As Engel had highlighted in the “Biopsychosocial” model of healthcare, in order to treat an individual as a whole, one cannot only focus on the biological aspect but adopt a holistic approach to consider the psycho-social and even spiritual aspects (Engel, G., 1981; Saad, M., de Medeiros, R. and Mosini, A., 2017). For instance, a service user’s physical signs and symptoms may indicate that they need medications to alleviate their pain and bring some relief. However, if the person had not seen any major changes with the use of medications or if they have been having some side effects, the individual may not be motivated to adhere to or comply with the treatment in such case it is a psychological or a behavioural matter. Similarly, if a service-user has been recommended a specific type of diet and to engage in exercise following a diagnosis of chronic conditions like diabetes, hypertension or cardiovascular diseases, after a certain period of time the person may lose interest or feel less motivated if they do not perceive any immediate changes (Khazrai, Y., Defeudis, G. and Pozzilli, P., 2014). This is also a behavioural matter, which can have an impact on their health outcome (Gonzalez, J., Tanenbaum, M. and Commissariat, P., 2016). In both examples, we can observe that behavioural matters can only be addressed through support and motivation on a regular basis. Apart from this, there can be various other barriers to treatment adherence and compliance such as disabilities, lack of right knowledge and understanding of the health conditions and the importance of treatment, mental health issues such as depression, cognitive conditions like dementia or just forgetfulness, economic status, access to timely treatment, personal beliefs, moods, attitudes, just to name a few. For instance, owing to the health conditions certain service-users may need enteral nutrition, which requires support and care (Gea Cabrera, A., Sanz-Lorente, M., Sanz-Valero et al., 2019). In such cases, the support of caregivers can be pivotal.

At Rexshi Healthcare, we understand your concerns and that of your loved ones. We have staff who are well-equipped to support a service-user through their treatment journey. We build a healthy relationship with our service users always prioritising their health and well-being. We work with the service-user and their loved ones to understand their complex needs, be it physical, mental or social. We strive to meet these complex needs through our person-centred care approach (check out our recent blog on person-centred care). We have nurses who will take care of the health needs such as administering the medications at the right time. With their help and motivation, the service-user will be able to be both adherent and compliant to medications. With our domiciliary care givers, making lifestyle changes have been made easy. They would help to cook nutritious and delicious meals according to the service-users’ liking. The service-user no longer needs to be bored with eating the same type of meals seven days a week. Our culturally competent staff will even cook to your taste (check out our recent blog on cultural competence). We provide help to prepare meals, buy groceries, get your prescription medications on time and even take our service-users to the doctor’s appointments. They do not have to be late for an appointment or miss it any longer! Also, as highlighted behaviour, moods, attitudes and mental health can be a serious matter when it comes to taking care of oneself. That is why at Rexhi Healthcare we offer support to combat loneliness. Our friendly staff will provide companionship, take service-users to their place of liking such as theatre, cinema or a park, and help pursue their hobbies such as playing chess, reading a book or knitting! The list goes on. In a nutshell, whatever your needs or that of your loved ones, we are here, just one phone call away.

References
Chakrabarti, S., 2014. What’s in a name? Compliance, adherence and concordance in chronic psychiatric disorders. World Journal of Psychiatry, 4(2), p.30.
De las Cuevas, C., 2011. Towards a Clarification of Terminology in Medicine Taking Behavior: Compliance, Adherence and Concordance are Related Although Different Terms with Different Uses. Current Clinical Pharmacology, 6(2), pp.74-77.
Engel, G., 1981. The Clinical Application of the Biopsychosocial Model. Journal of Medicine and Philosophy, 6(2), pp.101-124.
Gea Cabrera, A., Sanz-Lorente, M., Sanz-Valero, J. and López-Pintor, E., 2019. Compliance and Adherence to Enteral Nutrition Treatment in Adults: A Systematic Review. Nutrients, 11(11), p.2627.
Gonzalez, J., Tanenbaum, M. and Commissariat, P., 2016. Psychosocial factors in medication adherence and diabetes self-management: Implications for research and practice. American Psychologist, 71(7), pp.539-551.
Khazrai, Y., Defeudis, G. and Pozzilli, P., 2014. Effect of diet on type 2 diabetes mellitus: a review. Diabetes/Metabolism Research and Reviews, 30(S1), pp.24-33.
Saad, M., de Medeiros, R. and Mosini, A., 2017. Are We Ready for a True Biopsychosocial–Spiritual Model? The Many Meanings of “Spiritual”. Medicines, 4(4), p.79.