By Y. Sugut. Carleton College. 2018.
In addition order diovan 40 mg without a prescription, there is a large number of persons who also use antihypernsive medication generic 80mg diovan with visa, buhave noyereceived this certification discount 160mg diovan otc. Another large group is those patients who know thatheir blood pressure is raised, buwho have no medication aall. Recenfindings from the Framingham study showed thahalf of normonsive 55- year-olds and over two-thirds of normonsive 65-year-olds will develop hypernsion within the nexn years (Vasan eal. In the nexfew years, a very large number of Finns will reach the high-risk age (Suomen laaketilasto 2002). This will pose a challenge to the Finnish health care sysm, because hypernsion is an expensive disease due to its cardiovascular complications and medical treatments. In addition, the human suffering caused by hypernsion to the patients and their close relatives is immeasurable. Ihas been recently shown thaonly every fourth Finnish hypernsive patienin primary care has reached the goal of blood pressures values under 140/85 mmHg (Meriranta eal. These poor outcomes of hypernsion treatmenare alarming, buthey do nogive us any idea abouthe patients� perspectives of hypernsion treatment. Traditionally, medical treatmenhas held the key role in hypernsion 14 treatmenregardless of patients� concerns and wishes. As long as the focus of treatmenis something other than the patient, the patienperspective nds to gelost. The treatmenof hypernsion with adverse drug effects and symptoms may be very troublesome for the patient. Such aspects as patients� attitudes and perceived problems relad to differenaspects of hypernsion treatmenhave so far received little atntion in research. To betr understand the poor outcomes of treatment, we also need information from the patients� perspective. In 1976, David Sacketand Brian Haynes published one of the firsbooks on compliance, which was followed by a more comprehensive book (Brian Haynes, Wayne Taylor and David Sackett) in 1979 titled �Compliance in Health Care�, which summarized the sta of the arin compliance research. In this book, compliance was defined as �the exnto which a person�s behavior (in rms of taking medications, following diets, or executing lifestyle changes) coincides with medical or health advice�. According to Haynes (1979), the rms �compliance� and �adherence� can be used inrchangeably, while Lutfey and Wishner (1999), for instance, thoughthathe rm �adherence� includes more of the patient�s righto self- dermination concerning his/her treatmenthan the rm �compliance�. In his introduction to �Compliance in Health Care� Brian Haynes (1979) comments that, although some sps forward have been taken, however, the solution of non- compliance is still noin sight. Since then, the associations of compliance with over 200 background variables have been studied (Morisky eal 1986). The las30 years of research on compliance have noproduced much more reliable information than thapatients do noalways take their medications as prescribed (Morris and Schulz 1992). Furthermore, the studied variables have been mainly contradictory in differenstudies and are thus nouseful in explaining compliance (Morris and Schulz 1992). A quarr of a century afr the publication of firsbook, Brian Haynes and his colleagues (2002) commenthathere is a need for studies thaare able to improve compliance. Furthermore, the studies 16 thahave successfully used long-rm medications have been complex, and abest, have had only modesffects on non-compliance. In the lirature, when defining compliance there seems to be a common thoughthathe patient�s behaviour is the exclusive reason for non-compliance, withoutaking into accounthe roles of the physician, the health care organization and the patient-doctor relationship, which mighshow non-compliance to be due to concordance problems between the patienand health care professionals (Lutfey and Wishner 1999, Nilsson 2002). The problem with the rm �compliance� has been the perception thathe patienreceives commands from healthcare professionals. Therefore, the rm �concordance� was recently introduced, which looks acompliance from a differenperspective. Iis an agreemenreached afr negotiation between a patienand a healthcare professional tharespects the beliefs and wishes of the patienin dermining whether, when, and how medicines are to be taken� (Dickinson eal. The patient�s views should be taken into accounven if s/he does noactively participa in the decision-making process (Elwyn eal 2003). The making of maximally well- informed treatmendecisions is one of the keys to concordance (Dickinson eal. Thus, one importanrole of the physician is to ensure thathe patienhas adequa access to information and, when necessary provide an inrpretation of this information to the patien(Kennedy 2003). Furthermore, if the patienlets you know thas/he does nowanto take a certain medicine, the reasons for thashould be discussed (Elwyn eal 2003). Iis nomeaningful to discuss compliance when a patienhas been offered treatmenthas/he finds unacceptable because of ethical/moral or religious reasons, while concordance does nopresena problem in a corresponding situation. The patienhence has the righto choose whether or nos/he accepts the medication, and the health care professional should accepthis as a parof the process of moving from compliance to concordance (Heath 2003). However, there mighbe some situations where the use of �concordance� and the patienas a decision-maker are problematic. These are clinical trials where almosfull compliance is needed to ensure reliable results (Milburn and Cochrane 1997). The research on human medication-taking behaviour is also relad to compliance and thus 17 nosuitable for the �concordance� concep(Milburn and Cochrane 1997). Furthermore, �concordance� is nouseful in the case of pontially fatal infectious diseases because persons with this kind of disease will risk the health of other people by infecting them and contributing to bacrial resistance againsantibiotics (Milburn and Cochrane 1997). Ihas also been suggesd thathe decision to involve the patieninto decision-making should be made individually in each case by taking into accountheir comprehension and decision-making abilities (Lakshmi 1999, Lamon1999). Patients come to seek help from a physician, and if the decision-making is repeadly lefto the patiens/he may ultimaly lose respecfor the physician (Carvel 1999). However, the patienas a co- worker is essential for effective discussion between the patienand the physician, where mutual understanding will lead to a rapid diagnosis, and discussion of treatmenchoices may lead to a higher probability of good compliance (Slowie 1999).
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How tobacco smoke causes disease: The biology and behavioral basis for smoking-attributable disease: A report of the Surgeon General. This knowledge has opened the door to new ways of thinking about prevention and treatment of substance use disorders. This chapter describes the neurobiological framework underlying substance use and why some people transition from using or misusing alcohol or drugs to a substance use disorder—including its most severe form, addiction. The chapter explains how these substances produce changes in brain structure and function that promote and sustain addiction and contribute to relapse. The chapter also addresses similarities and differences in how the various classes of addictive substances affect the brain and behavior and provides a brief overview of key factors that infuence risk for substance use disorders. An Evolving Understanding of Substance Use Disorders Scientifc breakthroughs have revolutionized the understanding of substance use disorders. For example, severe substance use disorders, commonly called addictions, were once viewed largely as a moral failing or character faw, but are now understood to be chronic illnesses characterized by clinically signifcant impairments in health, social function, and voluntary control over substance use. Although3 the mechanisms may be different, addiction has many features in common with disorders such as diabetes, asthma, and hypertension. All of these disorders are chronic, subject to relapse, and infuenced by genetic, developmental, behavioral, social, and environmental factors. In all of these disorders, affected individuals may have difculty in complying with the prescribed treatment. Research demonstrating that addiction is driven by changes in the brain has helped to reduce the negative attitudes associated with substance use disorders and provided support for integrating treatment for substance use disorders into mainstream health care. This cycle becomes more severe as a person continues substance use and as it produces dramatic changes in brain function that reduce a person’s ability to control his or her substance use. These disruptions: (1) enable substance-associated cues to trigger substance seeking (i. It is not yet known how much these changes may be reversed or how long that process may take. All addictive drugs, including alcohol and marijuana, have especially harmful effects on the adolescent brain, which is still undergoing signifcant development. These effects account for the euphoric or intensely pleasurable feelings that people experience during their initial use of alcohol or other substances, and these feelings motivate people to use those substances again and again, despite the risks for signifcant harms.