noted problems that can contribute to poor health outcomes, adverse events, and emergency room visits (Sawicki, 1999; Cummings et al., 2000). Some prescription medications have a particularly high propensity to drug and food interactions; examples are warfarin, an anticoagulant, and monamine oxidase (MAO) inhibitors, an (older) class of antidepressant. One study found an abundance of adverse interactions between warfarin and commonly used medications and foods such as anti-infective agents, lipid-lowering drugs, nonsteroidal anti-inflammatories, certain antidepressants, anabolic steroids, fish oil, mango, green tea, and grapefruit juice, to name a few (Holbrook et al., 2005). In total, 34 reports of major interactions were confirmed in the study, as were 41 highly probable and 38 probable causations. Likewise, a wide range of drug and food interactions have been reported with the use of MAO inhibitors (Livingston and Livingston, 1996; NLM, 2005). Dangerous reactions such as sudden high blood pressure may result when these agents are taken with certain drugs, foods, or drinks, such as antihypertensives, asthma medicines, other antidepressants, cheese, poultry, fish, sausage, overripe fruit, alcoholic beverages, and high amounts of caffeine (NLM, 2005). Individuals taking these medications have a difficult time adhering to their regimens without adequate education and support mechanisms.

A number of factors affect individuals’ ability to engage in illness self-management such as their particular illness and life circumstances. Barriers to self-management generally fall into three categories: knowledge deficits (e.g., insufficient information, literacy issues); practical barriers (e.g., physiological, functional, or financial constraints); and attitudinal factors (e.g., personal beliefs, culture, values, and experiences). These barriers are discussed extensively in Chapter 4.

Conversely, several studies have noted certain individuals’ ability, given adequate education, to participate successfully in self-care and disease management for various health conditions, including diabetes, which requires frequent self-monitoring of blood glucose levels to make adjustments in self-administered insulin therapy; depression, which requires self-assessment of changes in psychosocial affect resulting from prescribed medications; and cancer, which requires self-monitoring of adverse reactions to powerful chemotherapy agents (Grissinger et al., 2003; Ikesue et al., 2004; Schroeder et al., 2004). For example, self-monitoring of glucose levels and strict adherence to insulin therapy or oral hypoglycemic agents, along with extensive patient education, lead to major improvements in medical outcomes and substantial decreases in long-term complications of diabetes (Tamada et al., 1999). Similar positive results were found in initial studies of patients receiving oral anticoagulation therapy (Sawicki, 1999). Self-management support programs that emphasized use of portable capillary whole-blood analyzers for regular testing of prothrombin time, together



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