COMPLIANCE OF THE ISABELA STATE UNIVERSITY STUDENTS TO PHYSICIANS PRESCRIPTION

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

Chapter I THE PROBLEM AND ITS BACKGROUND

Health is one of the essential components of life. It encompasses the general well-being of a person encompassing the physical, emotional, mental, social, environmental, and spiritual aspect of his life. Impairment to one of these aspects of health may affect the other aspects, thus health preservation and promotion is very important.

Concerning about health of every individual especially students is very important, in the fact that health is the foundation of every success. Sometimes, most students focus on their studies not knowing that their health is affected. Instead of buying medicines for them to relieve any pain they prioritize their needs in school. Even when one recognizes personal susceptibility to such illness, action will not occur unless the individual perceives that the illness is becoming severe.

Most students take primary regimen such as consulting to the school or university healthcare providers at their infirmaries when they perceive that something is wrong to their health. However there is no assurance whether they comply with the Physicians prescription such as following the right dose, time and duration of medications to be taken. There are many potential explanations for why students dont take prescribed drugs, ranging from cost to convenience to the patients not being totally convinced that the drug is necessary to treat an asymptomatic condition as stated by Kenneth Lin, MD(http://www.kevinmd.com/blog/2010/06/pa tients-prescription-drugs.html).

In another international study, Pauline Chen, in a recent New York Times column, discusses the worrisome issue of medication noncompliance. According to the data, it was stated that as many as half of all patients did not follow their doctors advice when it came to medications, and, more than 20 percent of first-time patient prescriptions were never filled.

In addition, third world governments have expanded the provision of primary health services, and with it, the number of prescriptions has increased phenomenally. However, little data were known about how third world patients are using prescribed medicines. In order to assess the available information, 37 empirical studies were reviewed on compliance to prescriptions located through electronic lines and networking.

By and large, the orientation of the studies is biomedical. The authors measure levels of compliance and advance recommendations to increase them. It was found out that there is little consistency in the definition of compliance and a variety of methodologies used in its measurement. In spite of methodological problems, most researchers found low levels of adherence to medical regimens. Low levels of adherence raise questions about the quality of care, iatrogenic effects caused by the inadequate use of modern medicines, and the health and economic impact of health investments.

At the same tie it is recognized that, given current prescribing practices and lack of efficacy of many medicines, compliance may add little to the quality of care. Compliance and prescribing behaviors should always be examined together and as part of quality of care assessments, as stated by Nuria Homedes and Antonio Ugalde in their study on Patients' compliance with medical treatments in the third world. What do we know? as posted by http://www.heapol.oxfordjournals.org/conte nt/8/4/291.abstract.

Most College students visiting the University or college infirmary or clinics are receiving Physicians prescription mostly containing the drugs to be taken. Physicians may give free medications but may not cover the complete days required for the drugs to be taken. There may be no assurance regarding the compliance of the students to Physicians prescription. The health of a person does not end from the time of consultation, it continues up to the how the client follow the specific prescription or advise.

This research study will be conducted to determine compliance of students of Isabela State University to Physicians prescription. Furthermore, the researchers of the study would like to determine effect of the factors namely Financial, Social, cultural, religion, psychological and emotional factors) to compliance of students to physicians prescription.

Background of the Study

The health care services of the Isabela State University-Echague, Isabela started in a small clinic located in the Administration building. It is a requirement for all the Universities to have their own clinic as per memorandum of Commission on Higher Education (CHED) inorder to provide healthcare services to all the students and university employees.

The services offered in clinic during those times were at the level of nursing care until eventually, medical and dental services were offered. Inorder to expand the health services of the University, the University officials and the University healthcare employees take the initiative to build an Infirmary.

The building of the infirmary started as a multipurpose building which was initially constructed on September 6, 2004 through the priority development assistance fund of Representative Ernesto C. Pablo, APEC Partylist. It was completed by ISU during the administration of Dr. Romeo R. Quilang, President to house the health Services of the University System that was inaugurated last June 10, 2008.

The Healthcare services offered by the infirmary consist of medical and dental services. Under the medical services are consultation, first aid and treatment, blood pressure taking, health teaching and referral. Ancillary services are also available which includes Glucose Testing, Electrocardiography, Blood Typing and Urinalysis. Under the dental services are tooth extraction, oral prophylaxis and dental check-up.

The university infirmary consists of the University Physician who is the head, two nurses, and one dentist and one dental aid.

As nursing students, we play a major role in health promotion and disease prevention. The university infirmary is one of the sources of health of student of Isabela State University. It is important to know if the student who have consulted infirmary have really complied with the physicians prescription since health improvement does not only depends on the time of consultation and interaction with the health care provider. Health of consumers will really improve if they really complied with the Physicians prescription.

Thus, the researcher will conduct the research study to determine the compliance if the ISU students to the Physicians and the factors affecting the students compliance.

Objectives of the Study

Generally, the research study will be conducted to determine the compliance of the Isabela State University students to Doctors prescription.

Specifically, the research study aims to determine the profile of the respondents, the factors affecting the students compliance to Doctors order, and the relationship between the factors and the students compliance to Physicians order.

Statements of the Problem

1. What is the profile of the respondents as to: 1.1. Age 1.2. Gender 1.3. Course and Year 1.4. Scholarships/Assistantships 1.5. Religion 1.6. Ethnicity 1.7. Income of parents 1.8. Occupation of parents 1.9. Type of illness as diagnosed by the University Physician

2. What are the factors affecting the compliance to Doctors prescription relative to: 2.1. Financial 2.2. Social 2.3. Cultural 2.4. Spiritual 2.5. Mental 2.6. Emotional

3. To what extent these factors affect the compliance of the respondents to Doctors prescriptions? 4. Is there a significant relationship between the factors and the compliance of the respondents?

Significance of the Study

The research study is to be conducted to determine the compliance of the Isabela State University students to Physicians prescription. Since the ISU students are the respondents of the 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 of the important components of health promotion and disease prevention.

Parents of the respondents are the next to be benefited after the respondents. Based on what will be the results of the study, parents will become more aware on supporting the needs of the students regarding health, and this includes financial and social support.

Aside from the respondents and the parents of the respondents, the University officials and healthcare officials will also be benefited. Depending on what will be the results of the study, the University officials and healthcare officials will become aware regarding the necessary modifications on policies regarding the healthcare services offered by the University, inorder to promote better health among the students.

Future researchers will also be benefited. They can conduct further evaluation on this study. They can also conduct new studies basing on this study such a way that they can apply the suggestion stated on literature of this study on the method of care given to students and evaluate the effectiveness of these additional suggestions to compliance of the students to Physicians prescription

Definition of Terms
The following words are the terms being used in the study. The following words are defined operationally. Assistantships this is included in the profile of the respondents. This includes the scholarship or financial supports that students receive form the school or other sources. Compliance action made by students to follow the Physicians prescription.

Cultural - relating to the arts and intellectual activity and considered one factor that can affect in complying Physician prescription Ethnicity in the study it is included in the profile of the students relating to ethnic affiliation or distinctiveness Financial one factor that can affect in complying Physicians prescription that pertains with money.

Illness any alteration in health felt by the students that may trigger them to consult in the infirmary Infirmary - it is a primary source of healthcare of the students and employees in the Isabela State University, Echague, Isabela. A place were the students and employees went for the treatment their illnesses, it consists of physician, nurses, and dentist

University Physician he is the one who heads the Isabela State University Infirmary who treat/help students and employees in certain illness and who prescribe medicine. Prescriptionaction made by the doctor, prescribe for the students who seek medication for their health Social one factor that can affect in complying physicians prescription relating with the way on how students interact with a group of people

Spiritual one factor that can affect in complying physician prescription relating with the quality or condition of being spiritual and religious affiliation

Scope and Delimitation

The scope of the study will be on determining the Compliance of Isabela State University students to Physicians Prescription and the factors affecting the Compliance of the students. The study will be limited only to those students of the Isabela State University who had consulted the University Infirmary within a month for the first semester of school year 2011.

Chapter II REVIEW OF RELATED LITERATURE

Several studies have been taken for the sustenance of research study. In one research regarding the Factors Affecting Students' Medicine-Taking Habits by C. E. Labig , K. Zantow, and T.O. Peterson, it was stated that the study examines college students' beliefs about health, prescriptions, doctors, and the influence those beliefs have on adherence to prescribed medication regimens.

After a brief review of attitudinal factors that influence adherence to prescription medicine directions, the authors discuss measurement issues and explain the reasons for their approach to studying adherence issues. The results of the exploratory study indicate that college students' adherence to a prescribed medication regimen is more strongly associated with beliefs about health, prescription drugs, and a self-cure orientation than students' satisfaction with their physicians.

In the sample of students, forgetfulness appears to be the dominant reason for nonadherence. One implication from these results is that adherence issues may be more appropriately addressed in campus promotions than in the medical clinic. The authors also offer suggestions for further research (Journal of American College Health Volume 54, Number 3 / NovemberDecember 2006).

Pauline Chen, in a recent New York Times column, that there are many potential explanations for why patients dont follow prescriptions such as taking the prescribed drugs. She claimed that patients non adherence with medication regimens remains one of the most important healthcare concerns; it is surprising that research in this area is sorely lacking.

Dr. Pauline Chen stated some multicausal phenomenon affecting the patients non adherence to prescription which includes, the seriousness of illness, the cost of treatment, the treatments side effects, the patients age, mental status and memory capacity the complexity of recommendation, the duration of regimen, the type of medical advice the clarity or unclarity of written instructions and accessibility.

Furthermore, Dr. Chen pointed out some possible solutions on how to improve the patients adherence to Physicians prescription. She stated that one solution would be to have pharmacy in the Physicians office where patients can pick up their medications on the way out.

She added that strategies for adherence include raising information and skill levels, altering characteristics of the regimens and improving the relationships between the healthcare provider and the patient. Provider and patients awareness with regard to medication adherence can be enhance with the creative application of the behavioral contracts thus Improving reinforcement.

Zasstocki and Rovinski-Wagner added suggestions on how to take medications properly to solve the problem of medication non adherence. Stated below are the following suggestions: TO TAKE MEDICATION PROPERLY Be sure you understand Each medications name Why you are taking the medication How much medication you should take

 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

 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 buy without prescriptions (over the counter) unless they are approved by your nurse or doctor -Do not use alternative medicine or herbal or vitamin supplements unless they are approved by your nurse or doctor.

 Follow any special safety precautions, such as -Keep your medications separate from other family members medications. Let your family and friends to help you Ask your nurse or doctor about community groups 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 as possible

 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 medication for the day -Scheduling your medications around usual routine such as meals -Using pictures or colored dots on bottles. For example red dots or a picture of a sun will tell you to take the medication in the morning

-Using an index card with a picture of the medication by your toothbrush could remind you to take medication in the morning or in bedtime -Using a medication organizer on the next page for example (HOME CARE; Patients and Family Instructions; Second Edition; Page 23)

In addition, in order that medication can achieve its intended benefit it is important that people complete the prescribed course or continue to take it when a chronic condition is present. Compliance refers to the extent to which people follow health advice or other prescribed regimens, including drug treatment. It may assume that most people comply with prescribed drug treatment; however, this is often not the case and there are many reasons or for this, including polypharmacy and difficulty in:

 Understanding why medication is necessary Understanding what benefits what the medication may have Remembering advice given to them Accepting disruption to their lives Accepting that they have condition that requires treatment

Potter and Perry emphasized that patients mentality is a factors associated with compliance to Physicians prescription especially in terms of medication adherence. Client knowledge about a prescribed medication varies with the person and depends on many factors. Some clients desire and receive detailed information about the medications they are taking, whereas other clients want and receive minimal information. Determine what the client already knows and what he or she needs to know to take medication safely. Then ask questions to elicit this information. Clearly document inadequate knowledge or gaps in important areas so that an individualized teaching plan can be formulated.

Assessing cognitive ability is important for individualizing the teaching plan and determining whether the client can independently manage self-medication. Cognitive impairment, confusion, and psychiatric disorders may increase the potential for difficulty with the medication regimen. Learning disabilities may necessitate creative teaching to ensure understanding and compliance with therapy. Include family members or the caregiver in the teaching sessions.

Compliance with a medication routine means, that the client takes the medication exactly as prescribed. Lack of compliance can occur in many ways, for example when client: does not take any of the prescribed drug; does not take the proper number of doses of the drug; takes extra doses of the drug; does not follow the dosage schedule as prescribed;

 discontinues the medication, prematurely; excessively uses a PRN order; Takes medication that was ordered previously for another condition. Clients are more likely to follow simple medication routines that suite their lifestyles. A clients attitude, about medical care and about specific medications can influence his/her compliance with drug therapy. Begin by asking general questions, such as, Do you believe that this medication will help you get better? Be alert to comments that indicate a clients lack of confidence in prescribed drug treatment.

Lifestyle and financial considerations also affect the compliance with drug therapy. The client with a regular income, health insurance, and a stable home is more likely to obtain medications and to organize routines to remember to take them. when a client does not have in a home, income, or health insurance, buying, storing, and remembering to take medications regularly can be difficult.

Compliance is a clients adherence to the prescribed course of therapy. Unfortunately not all 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 changing health practices, and they see the benefits to adopting a healthy behavior. The nurse assess the clients motivation to learn and what the client needs to know in order to promote compliance with the prescribed therapy (Fundamentals of nursing; seventh edition, 2009).

Taylor, Lillis, and Le Mone added that nurses play a great role for the compliance of patients. Nursing assessment of the patients learning needs is vital to developing a plan of care in with which the patient can comply. Patients are considered compliant when they follow the treatment plan and use the information they have been taught.

Noncompliance occurs when patients ignore instructions or do not follow them approximately. Noncompliance can also be associated with a lack of learning readiness and motivation, confusion, disappointment, misunderstanding, fear, inability to learn, or inadequately finances. When patients understands their diagnosis, treatment rationale, medication regimen and the benefits of compliance, they are more likely to comply. Noncompliance can hurt the patients health. Increased patients compliance is direct outcome of effective patients teaching (Fundamentals of nursing, Chapter 22, page 483).

In another study made by Steve Wilkins that factors affecting patients compliance are categorized into two groups namely: factors can be categorized into two groups: Unintentional non-adherence and Intentional non-adherence. Unintentional non-adherence is related to a patients ability and resources to take their medication (e.g., problems with manual dexterity, forgetfulness, inability to pay for medication, etc.).

Intentional non-adherence is associated with a patients motivation and beliefs, e.g., the reasons for needing a medication, the efficacy of a proposed treatment and concerns about side effects of medication or treatment (http://www.kevinmd.com). Patients who do not take the medications as prescribed or who do not recognize warning signs of illness exacerbation or drug side effects are at risk for unsuccessful results, adverse reactions, and poor quality of life. (Schatzberg et al, 2007).

The threats to patient adherence are many. Some of them come from the mental health team, others from the patient or family, and still others reflect a shared failure of the therapeutic alliance. Nurses, patients, and families should work together to minimize misunderstandings and unnecessarily complex medication regimen (Kozuki et al, 2005; Tay 2007). Too often clinicians blame patients for non-adherence without completing the following:

 Fully evaluating the treatment plan from the patients 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 than merely the reduction of symptoms Understanding the patients reasons for nonadherence

Synthesis of the Study

In the review of related literatures several studies were taken for the sustenance of research study. The different studies that were included in the review of related literatures, all pointed out to the factors affecting the compliance of patients (students) to Physicians prescription especially in terms of medication adherence,

these factors include the seriousness of illness, the cost of treatment, the treatments side effects, the patients age, mental status and memory capacity the complexity of recommendation, the duration of regimen, the type of medical advice the clarity or unclarity of written instructions and accessibility. In similarity with the research study, researchers also pointed out several factors that may affect the compliance of Isabela state University students to Physicians prescription, which includes the financial, social, mental, spiritual, cultural, and emotional factors.

On the other hand, the researchers have seen two differences between research study and studies included in the review of related literatures. First is that, the researchers want to determine as to what extent does the factor affects the compliance of Isabela state University students to Physicians prescription. Second, the studies on the review of related literature include suggestions on how to improve the compliance of patients to Physicians prescription which is not included in the research study.

Conceptual Framework
This study seeks to ascertain factors affecting the students compliance to Physicians prescription. Another inspiration behind all of these efforts is to determine if theres really a significant relationship between the factors affecting and the students compliance to Physicians prescription.

The summarization of the research to be conducted is shown in Figure 1 under conceptual paradigm. The relative factors include financial, social, cultural, spiritual, mental and emotional, while the profile of the respondents include age, gender, course and year, scholarships/assistantships, religion, ethnicity, income of parents, occupation of parents and type of illness as diagnosed by the University Physician.

Every shape used in conceptual paradigm has significance in order for the researcher to have pattern and basis in the study. Boxes in different sizes represent as an enclosing shape of the following: profile of the respondents, relative factors, compliance of the respondents to Physicians prescriptions and significance of the relationship of the three. Lines help to connect each of the enclosed words.

The one with the emphasized box is the compliance to Physicians prescription. The researcher made it to be emphasized since it will be the focus of the study, in which the profile of the respondents themselves and relative factors are connected to. This is to give a clue in part of the researcher to be focusing on, if the factors have really effect on students compliance to Physicians prescription and its extent of influence toward the compliance to Physicians prescription.

The lines connected from the profile of the respondents, relative factors and compliance to Physicians prescription are then again connected to significance of the relationship back to the profile of the respondents, pointing toward relationship or interrelatedness.

PROFILE OF THE RESPONDENTS -Age -Gender -Course and Year -Scholarships/Assistantships -Religion -Ethnicity -Income of parents -Occupation of parents -Type of illness as diagnosed by the University Physician

RELATIVE FACTORS

Financial

Social

Spirituality

Cultural

Psychological

Emotional

COMPLIANCE TO PHYSICIAN S PRESCRIPTION

SIGNIFICANCE OF THE RELATIONSHIP

Figure 1

Chapter III METHODOLOGY

Research Design/Method
The researcher will use the descriptive correlational design. Descriptive Research design is a valid method for researching specific subjects. The purpose of Descriptive studies is to observe, describe, and document aspects of a situation as it naturally occurs and sometimes to serve as a starting point for hypothesis generation or theory development. (Nursing research; eight edition by D. Polit and C. Beck, 2008.)

Respondents of the Study

The respondents of the study will be the students of the Isabela State University had consulted the University Infirmary within a month for the first semester of school year 2011.

Data Gathering Instrument

The data gathering instrument to be used for the research study will be a questionnaire regarding the demographic profile of the respondents namely Age, Gender, Course and Year, Scholarships/Assistantships, Religion, Ethnicity, Income of parents, Occupation of parents, and Type of illness as diagnosed by the University Physician and the factors affecting their compliance to Physicians prescription.

The questionnaires are used to determine as to what extent does the factors affect the compliance of the respondents. The questionnaires will be floated among the respondents. The Likert Scale is use in the questionnaire and the questions included are close ended questions and are answerable by means 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 (strongly disagree).

To come up with qualitative results, an interview with the respondents will be conducted. An interview guide will be use for the interview. The response of the respondents to the questions in the interview will be group depending on the interrelatedness of their answers.

Data Gathering Procedure

Step 1. The researchers will go to the University infirmary to get the list of names of the students who consulted the infirmary on a weekly basis within a period of one month in the first semester School year 2011.

Step 2. After getting the list of names of the students who consulted the infirmary, the researcher will ask consent from the student. If the student granted the consent, he/she will be the respondent of the study. However, if the respondent refused to grant the consent, he/she has the right and this will be respected by the researchers.

Step 3. The researchers will conduct a follow up interview with the respondents (the ISU students who consulted the University infirmary within a month. A follow-up interview will be conducted with the respondents, and an interview guide will be use during the interview. The interview guide consists of questions regarding the compliance of the students to Physicians prescription.

Step 4. The researchers will float questionnaires to the respondents. The questionnaires consist of the questions regarding the profile of the respondents and the factors affecting the compliance of the students to physicians prescription. This is done to determine as to what extent does the factors indicated affects the compliance of students to physicians prescription.

Before the questionnaires are floated among the respondents, a Pilot testing will be done first in which the researchers will do pre-testing of questionnaires to some of the respondents. To accomplish the Pilot testing, the researchers will get some of the respondents (but not all) and let them answer the questions in the questionnaire. The Pilot testing is done to determine the validity of questionnaires. Those students who answered the questions during the Pilot testing will not be included anymore as respondents of the study. If the questionnaires are valid after the Pilot testing, the researchers will float the questionnaires among all the respondents.

But, if after the Pilot testing, there are some questions that should be modified, the researchers will modify specific questions before floating the questionnaires to all the respondents. This is done to ensure that the respondents will not encounter difficulty in answering or understanding the questions.

Step 5. After the interview with the respondents and after floating the questionnaires among the respondents, the researchers will begin analyzing and interpreting data. Regarding the interview, the answers of the respondents will be group according to similarity or interrelatedness of their answers.

Regarding the questionnaires, specific statistical tools will be used to group the profile of the respondents and to determine as to what extent does the factor affect the compliance to physicians prescription. The data will be organized, tabulated and tallied. The researchers will get the percentage, mean, frequency of the data.

A percentage and frequency distribution will be used in analyzing the data regarding the profile of the respondents. In terms of analyzing the data on the questionnaire regarding the different factors included, the mean of the response of the respondents will be use to analyze the data.

Chapter IV RESULTS AND DISCUSSION

Table 1. Frequency and Percentage distribution of Respondents according to their personal background Table 2. Mean Distribution of the Factors affecting the Compliance of Isabela State University students to Physicians Prescription

Reference List Fundamentals of Nursing, Human Health and Function Fifth Edition by: Ruth F. Craren, Concstance Hirnle; Chapter 29 (); Pages 561562. Fundamentals of Nursing Practice, Fundamentals of Holistic Care foreword by Roger Watson, Edited by Chris Broocker and Anne Waugh; Chapter 22 Promoting the Safe Administration of Medicines by Christine Burton and Jayne Donaldson; Page 648.

HOMECARE; Patients and Family Instructions: Second Edition; Page 23 Journal of American College Health; Volume 54, Number 3/November-December 2006 D. Polit and C. Beck. Nursing research; eight edition, 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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