The effects of non-compliance on the medical aid scheme

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THE ROLE OF THE CASE MANAGER

Case managers (CMs) play a vital role in the DRM programme. Most CMs are registered/professional nurses. The role of the CM is to contact each client on a regular basis. They set goals jointly and targets to help clients with the self-management of their illnesses on a daily basis (Breitenbach & Aldridge 2004:23). Bodenheimer, Lorig, Holman and Grumbach (2002:2469) are of the opinion that self-management education teaches patients problem-solving skills giving them confidence to manage their own illnesses to achieve their desired goals. Programmes teaching self-management skills are more effective than information on asthma only. Patient education in improving clinical outcomes can reduce costs for asthma patients.

The effects of non-compliance on the medical aid scheme

The medical aid scheme is also affected by the effects of non-compliance of asthma patients. The ED and hospital claims have to be settled by the medical aid scheme, and extra medications, prescribed for the patient when admitted also have to be paid for. Treatment of asthma in ED or hospitals accounts for a significant portion of total treatment costs. Patients visiting ED could either be treated and discharged or admitted to the hospital. A study which was conducted in the USA in 1996 – 1997 shows that out of the 2149 patients who visited the ED, the average cost per visit was $234 and for hospitalised patients the average length of stay was 3.8 days and the cost was $3,102.53 (Stanford, McLaughlin & Okamoto 1999:211).

Non-experimental research

The study used the non-experimental research design because data collection was done without introducing any new treatment or changes to the subjects. According to Polit and Beck (2004:188) most studies in nursing involve human subjects and are therefore not suitable for experimental manipulation. As this is a descriptive study, experimental research was also inappropriate. The researcher requested the participants to respond to items in a self-completion questionnaire regarding their knowledge and self-care actions.

Sampling procedure

There were 1 039 members registered for the asthma DRM programme of the particular medical aid scheme. The researcher used the spreadsheet of members of the particular medical aid scheme registered for the asthma programme as a sampling frame. Twenty out of the first thirty members were selected for pre- testing the questionnaire. Then 200 members and/or their dependants were selected by choosing every fifth member from the spreadsheet. A non-clinical staff member assisted with the determination of the sample and their postal and e-mail addresses. The questionnaires were mailed to the members’ postal addresses. Four weeks later follow-up reminders were sent through electronic mail to prompt members to complete and return the questionnaires to the researcher.

Reliability of the questionnaire

Burns and Grove (2005:374) state that reliability of a measure denotes the consistency of measures obtained in the use of a particular instrument and in the measurement method. The closed and open-ended questions and the Likert rating scale were used to structure the questionnaire. Reliability takes into account such characteristics as stability, internal consistency and equivalence (Polit & Beck 2004:416). Stability is the degree to which the instrument will yield the same results on two separate administrations. The stability of the instrument can be established by using the test-retest reliability. Due to time constrains, it was not possible to use the testretest method to assess the stability of this instrument.

Chapter 1 Overview of the study :

• 1.1 INTRODUCTION
• 1.2 BACKGROUND AND RATIONALE
• 1.3 STATEMENT OF THE RESEARCH PROBLEM
• 1.4 PURPOSE OF THE STUDY
• 1.5 RESEARCH QUESTION
• 1.6 RESEARCH OBJECTIVES
• 1.7 SIGNIFICANCE OF THE STUDY
• 1.8 THEORETICAL FRAMEWORK OF THE STUDY
  • 1.8.1 Assumptions underlying the Health Belief Model
• 1.9 DEFINITION OF KEY CONCEPTS
• 1.10 RESEARCH METHODOLOGY
  • 1.10.1 Research design
  • 1.10.2 Population
  • 1.10.3 Sample and sampling techniques
  • 1.10.4 Method of data collection
  • 1.10.5 Measures to ensure validity and reliability
  • 1.10.6 Method of data analysis
  • 1.10.7 Ethical considerations
• 1.11 SCOPE AND LIMITATIONS OF THE STUDY
• 1.12 OUTLINE OF THE STUDY
• 1.13 CONCLUSION
• Chapter 2 Literature review
  • 2.1 INTRODUCTION
  • 2.2 THE HEALTH BELIEF MODEL (HBM)
    • 2.2.1 Assumptions of the Health Belief Model
      • 2.2.1.1 Perceived susceptibility
      • 2.2.1.2 Perceived severity
      • 2.2.1.3 Perceived benefits
      • 2.2.1.4 Perceived barriers
      • 2.2.1.5 Cues to action
      • 2.2.1.6 Self-efficacy
• 2.3 THE NATURE OF ASTHMA
  • 2.3.1 Treatment of asthma
  • 2.3.2 Research about compliance to the treatment programmes
• 2.4 DISEASE MANAGEMENT
  • 2.4.1 Programmes and guidelines
  • 2.4.2 Factors contributing to the compliance of clients to the programme
• 2.5 THE ROLE OF THE CASE MANAGER
• 2.6 THE EFFECTS OF NON-COMPLIANCE
  • 2.6.1 The effect of non-compliance for the asthma patients/dependants
  • 2.6.2 The effects of non-compliance on the medical aid scheme
• 2.7 CONCLUSION
• Chapter 3 Research design and methodology
  • 3.1 INTRODUCTION
  • 3.2 RESEARCH DESIGN
    • 3.2.1 Non-experimental research
    • 3.2.2 Quantitative approach
    • 3.2.3 Descriptive research
  • 3.3 RESEARCH METHOD
    • 3.3.1 Research population
    • 3.3.2 Sample and sampling
    • 3.3.3 Sampling procedure
• Chapter 4 Data analysis and findings
  • 4.1 INTRODUCTION
  • 4.2 DEMOGRAPHIC DATA
    • 4.2.1 Age
    • 4.2.2 Gender
    • 4.2.3 Family history of chronic illnesses
    • 4.2.4 Lifestyle
      • 4.2.4.1 Eating habits
      • 4.2.4.2 Smoking
      • 4.2.4.3 Exercise
    • 4.2.5 Annual check-ups
    • 4.2.6 Laboratory tests
    • 4.2.7 Asthma status
  • 4.3 KNOWLEDGE ABOUT THE DISEASE
  • 4.4 MEDICATION COMPLIANCE
  • 4.5 ASTHMA TREATMENT
• Chapter 5 Conclusions, limitations, guidelines and recommendations

GET THE COMPLETE PROJECT
COMPLIANCE AMONG MEMBERS REGISTERED FOR THE ASTHMA DISEASE RISK MANAGEMENT PROGRAMME OF A PARTICULAR MEDICAL AID SCHEME