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Hesitancy Regarding Medical Advice on COVID-19: An Emergency Department Perspective

Published online by Cambridge University Press:  20 January 2022

Sarper Yilmaz
Affiliation:
Department of Emergency Medicine, Kartal Dr Lütfi Kırdar City Hospital, Istanbul, Turkey
Figen Ünal Çolak
Affiliation:
Faculty of Communication Science, Anadolu University, Eskişehir, Turkey
Nihat Müjdat Hökenek
Affiliation:
Department of Emergency Medicine, Kartal Dr Lütfi Kırdar City Hospital, Istanbul, Turkey
Rohat Ak*
Affiliation:
Department of Emergency Medicine, Kartal Dr Lütfi Kırdar City Hospital, Istanbul, Turkey
*
Corresponding author: Rohat Ak, Email: [email protected].

Abstract

Objective:

The rejection of or non-compliance with treatment arises for different reasons by patients who receive treatment recommendations for various diseases. These states are described by various concepts, such as discharge against medical advice (DAMA) and medication nonadherence (MNA). The basis of the study is to determine how these states have arisen during the coronavirus disease (COVID-19) pandemic.

Method:

The data of this study were collected through standardized interviews with 103 volunteer participants who were diagnosed with COVID-19 at different times and who did not use their prescribed medicine during the pandemic in Turkey. The data obtained in the research were analyzed through the MAXQDA qualitative analysis program.

Results:

As a result of the analysis of the data, 4 main themes and sub-codes have been reached: (1) prescribed medicine, (2) an information source for the COVID-19 period/treatment, (3) the reason for medication nonadherence, and (4) treatment of choice. When the approach toward treatment of patients who were diagnosed with COVID-19 and had started treatment by a physician was evaluated, it was revealed that the nonadherence state emerged as a cycle. In the initial period, nonadherence due to the medication itself was observed. The second period is when the patients recognize their disease and collect information from their environment. Although this period begins before the disease, the search for informative sources intensifies, especially once the diagnosis has been received. In the third period, with their diagnosis and the information they had obtained, patients consider the reasons to use the medication and then decide whether or not to use it. In the fourth period, the patients who will not use antivirals consider other medications, such as anti-flu, anticoagulant, supplements, and nutrition.

Conclusion:

Since a specific treatment protocol has not yet been revealed for COVID-19, a new conceptual framework is required. In the current condition, the state of “hesitation for medical advice” arises for non-hospitalized patients.

Type
Original Research
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

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References

Nahid, P, Dorman, SE, Alipanah, N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: treatment of drug-susceptible tuberculosis. Clin Infect Dis. 2016;63(7):e147-e195. doi: 10.1093/cid/ciw376 Google ScholarPubMed
Walsh, JC, Mandalia, S, Gazzard, BG. Responses to a 1 month self-report on adherence to antiretroviral therapy are consistent with electronic data and virological treatment outcome. AIDS. 2002;16(2):269-277. doi: 10.1097/00002030-200201250-00017 CrossRefGoogle ScholarPubMed
Hadadi, A, Khashayar, P, Karbakhsh, M, Vasheghani Farahani, A. Discharge against medical advice from a Tehran emergency department. Int J Health Care Qual Assur. 2016;29(1):24-32.Google ScholarPubMed
Albayati, A, Douedi, S, Alshami, A, et al. Why do patients leave against medical advice? Reasons, consequences, prevention, and ınterventions. Healthcare (Basel). 2021;9(2):111.CrossRefGoogle ScholarPubMed
Haynes, RB, McDonald, H, Garg, AX Montague P. Interventions for helping patients to follow prescriptions for medications. Cochrane Database Syst Rev 2002;2:CD000011.CrossRefGoogle Scholar
Southern, WN, Nahvi, S, Arnsten, JH. Increased risk of mortality and readmission among patients discharged against medical advice. Am J Med. 2012;125(6):594-602.Google ScholarPubMed
Lu, R, Zhao, X, Li, J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for irüs origins and receptor binding. Lancet. 2020;395(10224):565-574.Google Scholar
Ak, R, Kurt, E, Bahadirli, S. Comparison of 2 risk prediction models specific for COVID-19: the Brescia-COVID Respiratory Severity Scale versus the Quick COVID-19 Severity Index. Disaster Med Public Health Prep. 2021;15(4):E46-E50. doi: 10.1017/dmp.2021.141 CrossRefGoogle ScholarPubMed
Izda, V, Jeffries, MA, Sawalha, AH. COVID-19: a review of therapeutic strategies and vaccine candidates. Clin Immunol. 2021;222:108634.CrossRefGoogle ScholarPubMed
Chakraborty, C, Sharma, AR, Sharma, G, et al. SARS-CoV-2 causing pneumonia-associated respiratory disorder (COVID-19): diagnostic and proposed therapeutic options. Eur Rev Med Pharmacol Sci. 2020;24(7):4016-4026.Google ScholarPubMed
Meo, SA, Klonoff, DC, Akram, J. Efficacy of chloroquine and hydroxychloroquine in the treatment of COVID-19. Eur Rev Med Pharmacol Sci. 2020;24(8):4539-4547.Google ScholarPubMed
Reis, G, Moreira Silva, EADS, Medeiros Silva, DC, et al. Effect of early treatment with Hydroxychloroquine or Lopinavir and Ritonavir on risk of hospitalization among patients with COVID-19: the TOGETHER randomized clinical trial. JAMA Netw Open. 2021;4:e216468.CrossRefGoogle ScholarPubMed
Self, WH, Semler, MW, Leither, LM, et al. Effect of Hydroxychloroquine on clinical status at 14 days in hospitalized patients with COVID-19: a randomized clinical trial. JAMA. 2020;324:2165.CrossRefGoogle ScholarPubMed
Tang, W, Cao, Z, Han, M, et al. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial. BMJ. 2020;369:m1849.CrossRefGoogle ScholarPubMed
PRINCIPLE Trial Collaborative Group. Azithromycin for community treatment of suspected COVID-19 in people at increased risk of an adverse clinical course in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial. Lancet. 2021;397:1063.Google Scholar
Evaluation and Licensing Division, Pharmaceutical and Food Safety Bureau. Ministry of Health, Labour and Welfare. Avigan Tablet 200 mg. Report on the Deliberation Results. Published March 4, 2014. Accessed January 23, 2014. https://www.pmda.go.jp/files/000210319.pdf Google Scholar
Wang, M, Cao, R, Zhang, L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res. 2020;30:269-271. https://doi.org/10.1038/s41422-020-0282-0 CrossRefGoogle ScholarPubMed
Cai, Q, Yang, M, Liu, D, et al. Experimental treatment with Favipiravir for COVID-19: an open-label control study. Engineering. 2020;6(10), 1192-1198. https://doi.org/10.1016/j.eng.2020.03.007 CrossRefGoogle ScholarPubMed
WHO. R&D Blueprint COVID 19 Experimental Treatments. COVID Classification of treatment types. 2020. Accessed April 28, 2020. https://www.who.int/docs/default-source/coronaviruse/covid-classification-of-treatment-types-rev.pdf?sfvrsn=5b90b2f2_1&download=true Google Scholar
Yılmaz, S. COVİD-19 Pandemisi Süresince Sağlık Bakanlığı Tarafından Yayınlanan Kılavuzlardakı Dinamik Değişikliklere Genel Bakış. Journal of ADEM. 2020;1(2):20-30.Google Scholar
Yıldırım, A, Şimşek, H. Sosyal Bilimlerde Nitel Araştırma Yöntemleri. 5th ed. Baskı, Ankara: Seçkin Yayıncılık, 2005.Google Scholar
Miles, MB, Huberman, AM. Qualitative data analysis: an expanded source book. 2nd ed. Thousand Oaks, CA: Sage; 1994.Google Scholar
Aristotle. Rhetoric. (Trans. Doğan M). İstanbul: Yapı Kredi Yayınları; 2015. [in Turkish]Google Scholar
Shapiro, GK, Tatar, O, Dube, E, et al. The vaccine hesitancy scale: psychometric properties and validation. Vaccine. 2018;36(5):660-667. doi: 10.1016/j.vaccine.2017.12.043 CrossRefGoogle ScholarPubMed
McDonald, HP, Garg, AX, Haynes, RB. Interventions to enhance patient adherence to medication prescriptions: scientific review [published correction appears in JAMA. 2003;289(24):3242]. JAMA. 2002;288(22):2868-2879. doi:10.1001/jama.288.22.2868CrossRefGoogle Scholar
Sørensen, K, Van den Broucke, S, Fullam, J, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2012;12:1.CrossRefGoogle ScholarPubMed
Bosworth, HB, Granger, BB, Mendys, P, et al. Medication adherence: a call for action. Am Heart J. 2011;162:412-424.CrossRefGoogle ScholarPubMed
Hugtenburg, JG, Timmers, L, Elders, PJ, et al. Definitions, variants, and causes of nonadherence with medication: a challenge for tailored interventions. Patient Preference and Adherence. 2013;7:675-682. doi: 10.2147/PPA.S29549.Google ScholarPubMed
Tamblyn, R, Eguale, T, Huang, A, et al. The ıncidence and determinants of primary nonadherence with prescribed medication in primary care. Ann Intern Med. 2014;160:7.CrossRefGoogle ScholarPubMed
Goldman, DP, Joyce, GF, Zheng, Y. Prescription drug cost sharing. JAMA. 2007;298:1. doi: 10.1001/jama.298.1.61 CrossRefGoogle ScholarPubMed
McHorney, CA, Schousboe, JT, Cline, RR, Weiss, TW. The impact of osteoporosis medication beliefs and side-effect experiences on non-adherence to oral bisphosphonates. Curr Med Res Opin. 2007;23:12. doi: 10.1185/030079907X242890 CrossRefGoogle ScholarPubMed
Sbarbaro, JA. The patient-physician relationship: compliance revisited. Ann Allergy. 1990;64:325.Google ScholarPubMed
Osterberg, L, Blaschke, T. Adherence to medication. N Engl J Med. 2005;353(5):487-497. doi: 10.1056/NEJMra050100 CrossRefGoogle ScholarPubMed
Pablos-Méndez, A, Knirsch, CA, Barr, RG, et al. Nonadherence in tuberculosis treatment: predictors and consequences in New York City. Am J Med. 1997;102:164.CrossRefGoogle ScholarPubMed
Bosworth, HB, Granger, BB, Mendys, P, et al. Medication adherence: a call for action. Am Heart J. 2011;162:412-424.CrossRefGoogle ScholarPubMed
Siddiqi, HK, Mehra, MR. COVID-19 illness in native and immunosuppressed states: a clinical-therapeutic staging proposal. J Heart Lung Transplant. 2020;39(5):405-407. Accessed March 20, 2020, Available at: https://www.ncbi.nlm.nih.gov/pubmed/32362390 CrossRefGoogle Scholar
Ivashchenko, AA, Dmitriev, KA, Vostokova, NV, et al. AVIFAVIR for treatment of patients with moderate COVID-19: interim results of a phase II/III multicenter randomized clinical trial. Clin Infect Dis. 73(3):531-534. doi: 10.1093/cid/ciaa1176 CrossRefGoogle Scholar
Solaymani-Dodaran, M, Ghanei, M, Bagheri, M, et al. Safety and efficacy of Favipiravir in moderate to severe SARS-CoV-2 pneumonia. Int Immunopharmacol. 2021;95:107522.CrossRefGoogle ScholarPubMed
TC Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. COVID-19 (SARS-CoV-2 Enfeksiyonu) Erişkin Hasta Tedavisi. Published May 7, 2021. Accessed July 2, 2021. https://covid19.saglik.gov.tr/Eklenti/42578/0/covid-19rehberieriskinhastayonetimivetedavi-12022022pdf.pdfGoogle Scholar
Coronavirus (COVID-19) Update: FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine. US FDA. June 15, 2020. Accessed June 16, 2020. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-revokes-emergency-use-authorization-chloroquine-and Google Scholar
Venegas-Vera, AV, Colbert, GB, Lerma, EV. Positive and negative impact of social media in the COVID-19 era. Rev Cardiovasc Med. 2020;21(4):561-564. doi: 10.31083/j.rcm.2020.04.195 Google ScholarPubMed
Mehra, MR, Ruschitzka, F, Patel, AN. Retraction—Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis [retraction of Mehra MR, Ruschitzka F, Patel AN. In: Lancet. 2020;May 22]. Lancet. 2020;395(10240):1820. doi: 10.1016/S0140-6736(20)31324-6 CrossRefGoogle ScholarPubMed
Edifor, EE, Brown, R, Smith, P, Kossik, R. Non-Adherence Tree Analysis (NATA)—an adherence improvement framework: a COVID-19 case study. PLoS One. 2021;16(2):e0247109. Published online February 19, 2021. doi: 10.1371/journal.pone.0247109 CrossRefGoogle ScholarPubMed
Markowitz, K, Strickland, M, Huang, A. Fever and other clinical ındicators may fail to detect COVID-19-ınfected ındividuals. J Evid Based Dent Pract. 2020;20(4):101499. doi: 10.1016/j.jebdp.2020.101499 CrossRefGoogle ScholarPubMed
Gahche, J, Bailey, R, Burt, V, et al. Dietary supplement use among U.S. adults has increased since NHANES III (1988-1994). NCHS Data Brief. 2011;61:1-8.Google Scholar
Im, JH, Je, YS, Baek, J, et al. Nutritional status of patients with COVID-19. Int J Infect Dis. 2020;100:390.CrossRefGoogle ScholarPubMed
Thomas, S, Patel, D, Bittel, B, et al. Effect of high-dose zinc and ascorbic acid supplementation vs usual care on symptom length and reduction among ambulatory patients with SARS-CoV-2 infection: the COVID A to Z randomized clinical trial. JAMA Netw Open. 2021;4:e210369.CrossRefGoogle Scholar