PATIENT COMPLIANCE

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PATIENT COMPLIANCE    Hippocrates wrote:   “Keep watch also on the faults of the patients, which often make them lie about the taking of things prescribed”   Synonyms: compliance, adherence, concordance   Compliance as a partnership between patients, physicians and even managed care to achieve desired health outcomes – now called “concordance”. According to World Health Organization (WHO), the term adherence may be defined as: the extent to which a person’s behavior (e.g. taking medication, following a diet and/or executing lifestyle changes) corresponds with agreed recommendations from a health care professional, i.e. how patients adhere to their treatments.   Compliance or adherence is important for optimum therapeutic outcome which improves patient’s quality of life. Noncompliance usually results in increased morbidity (sickness) treatment failures, exacerbation of disease, more frequent physician visits, increased hospitalizations and even death   Four types of patients:   

  1. Noncompliers: Those who do not accepts the diagnosis and need for treatment at this time.

 

  1. Partial compliers: Those who accept the diagnosis and need for treatment but cannot fulfill the recommended actions sufficiently to reach targeted improvements in their health.

  

  1. Over-compliers: Those who take more than the recommended amount of medication or who diet or exercise in excess (These patients are rare).

 

  1. Adequate compliers: Those who follows the health advice adequately (i.e. enough medication, diet, exercise, to improve or control their medical disorder).

   Method to measure compliance:   There are various methods such as asking patients, counting unused pills, observing prescription refill rate. Various electronic monitoring devices are also available for measuring compliance in which some are widely used in clinical trials and some clinical care situations. Examples: bottle cap, inhaler, liquid dispenser monitors and automated pill counters etc.   

Strategies to improve compliance

  

         Interaction with pharmacist, through counseling and communication, etc.

 

         Multimedia educational campaigns

 

         Patient education, counseling, written information, special labels

 

         Teaching methods for self monitoring

 

         Devices, reminders (mail, telephone), special packaging

          Follow-up    Measuring compliance is difficult, as it is dependent on the cooperation of the patients. Indirect method such as counting unused pills or tablets, prescription refill rate, asking patients, measurements of drug wastage are not precise enough for the purposes of most studies. On the other hand, direct methods (e.g. using marker substances or blood serum analyses) are very expensive and often unpleasant for the patient. The use of modern microchip technology to record when drugs are administered (e.g. built into metered aerosol inhalers) could help in the future to obtain more accurate data about time and frequency of drug administration. 

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Devyani's picture
Author: Devyani

Comments

Dixon Thomas's picture

Thank you Devyani,
Its an outstanding representation about patient compliance
Compliance, adherence or concordance which term you prefer more for a wider use?
DOTS (directly observed treatment short-term) is an approach to improve patient adherence
DIXON THOMAS
MDCP, BELA POST
KERALA, INDIA 671321
http://www.pharmainfo.net/pharmacistdixon

Mr. Dixon Thomas, M. Pharm, M. S., RPh Assoc. Prof., RIPER 

 

Devyani's picture

Dear Sir,

Thank you for your comment

Sir, Compliance is term which previously widely accepted later instead of compliance adherence is came in existence and people started using it widely ……………..currently concordance is latest synonym for compliance.
And according to me adherence is term I prefer for wider use because concordance is new term just introduced in health care profession.
Daily health education delivered at DOTS centers is strongly associated with improved adherence.

Regards,
Devyani

My Page Link : http://www.pharmainfo.net/devyani

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AFSANEH REZVAN's picture

Exotic piece of information...........
Compliance is very much important for obtaining expected clinical outcome
It is very difficult in chronic diseases like HTN, DM, TB etc..
Good efforts dear…….keep going on……………

Regards,
AFSANEH REZVAN
http://www.pharmainfo.net/afsanehr

The Pharmacy Cares
http://www.pharmainfo.net/blog/-pharmacy-cares

Devyani's picture

This is very much true afsaneh that compliance is very important in chronic diseases management
due to so many reasons like long duration of therapy, complicated drug regimens, other patient related factors etc....
Regards,
Devyani
My Page Link : http://www.pharmainfo.net/devyani

The Pharmacy Cares
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Dixon Thomas's picture

Dear Devyani
Thank you for the awsome answer,
you are also an expert in patient counseling, but the question is doctors say what is the difference between the advise they give and counseeling
agin there is psychiatric counseling, family counseling, so thing if some more better term comes for the same it could grow better and be unique to pharmaceutical care
what you suggest?
DIXON THOMAS
MDCP, BELA POST
KERALA, INDIA 671321
http://www.pharmainfo.net/pharmacistdixon

Mr. Dixon Thomas, M. Pharm, M. S., RPh Assoc. Prof., RIPER 

 

Devyani's picture

Dear Sir,
In real practice we have seen some examples where doctors fail to provide required information to the patient. one example is during our ACPI's patient care work we visited one diabetic patient he asked us "please help me to understand the function of glucometer" .......we did it properly after that he commented that his family doctor don’t know about this ........so like this so many examples u will find in real practice apart form this one of the reason for medication error is dosage regimen bid, tid etc…… doctors due to so many reasons fail to provide exact information at what time patient has to take medication………… it's not simply morning, afternoon and evening......as a pharmacist we have good knowledge of pharmacokinetics of drugs so it's half life and other factors are very important during counseling ........our means pharmacists job is clearly not prescribing but only helping patient to know their medication, identify the drug therapy problems, monitoring and documentation this is difficult for physicians to do simultaneously during their routine work
There is clear cut difference between our and physicians job profile one should not mix and create confusion.
Pharmaceutical care is services where pharmacists have to provide real patient care services. Patient counseling is key principle in pharmaceutical care.
Thanking you for your comment

Regards,
Devyani
My Page Link : http://www.pharmainfo.net/devyani

The Pharmacy Cares
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Shiv Majumdar's picture

My Page : http://www.pharmainfo.net/majumdarshiv
Dear Devyani,

Very informative blog.

Yeah you explain the merits & demerits of other conventional method over microchip technology, don't you think this will also have high expense?

Keep sending such informative blog.

Regards
Shiv

Devyani's picture

Dear Sir,
You are very much true…….. use microchip technology leads to increase in cost but some researches are going on for cost-effective microchip technology for measuring compliance...so in near future we can expect good news as noncompliance itself cause increase of cost therapy due to so many reasons…….
Thanking you for your suggestions and questions

Regards,
Devyani
My Page Link : http://www.pharmainfo.net/devyani

The Pharmacy Cares
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Ankita Desai's picture

Dear Devyani,
Unlike all your previous blogs this blog too is very interesting and deals with a very sensitive issuewhich is usually not pondered over by us. The efforts taken by you are really appreciable.

Best Wishes,
Ankita

Devyani's picture

Thank you Ankita
Readers support and comments make us to grow professionally
Keep sending ur suggestions too.

Regards,
Devyani
My Page Link : http://www.pharmainfo.net/devyani

The Pharmacy Cares
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Zarrin Faria's picture

Hiii DEvyani...
An excellent topic to bring to the notice of the readers......
Patient complaince is a bring problem which is being faced by the heakthcare sector for centuries or even from before that....i guess the poor patient complaince has given birth to the various long duration dosage forms like SUSTAIN RELEASE TABLETS,
SUBCUTANEOUS IMPLANTS that last for 6 months etc...
Regrds,
Faria Zarrin
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Devyani's picture

Dear Faria,
Yes, this is one of the way to avoid noncompliance in patients other example is FDCs.........

Regards,
Devyani
My Page Link : http://www.pharmainfo.net/devyani

The Pharmacy Cares
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Eswar GsnkRao's picture

Dear Devyani,
Whatever the proper diagnosis and treatment is provided to a patient It is said to be waste if the patient doesn't take it properly. There te knowledge and discussion od compliance arises. The success of treatment highl depends on the co-operation by patient. Because every time the patient may not be observed by a pharmacist or even by his/her family members unless in rare cases. So the compliance of patient is highly required and appreciable.

Regards
eswar :-)

Regards

ESWAR :-) 

Devyani's picture

Thank you sir for your comment

thanking you
Regards,
Devyani
My Page Link : http://www.pharmainfo.net/devyani

The Pharmacy Cares
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Himanshu saurabh's picture

Is there a specific procedure followed to ensure patient compliance??
Regards,
Himanshu Saurabh

Devyani's picture

Dear Himanshu,

There is no specific procedure to ensure patient compliance as in different disease condition different dosage regimens and medical devices are used other is duration of therapy and patient related ,drug related factors usually affect on compliance so...............

Regards,
Devyani
My Page Link : http://www.pharmainfo.net/devyani

The Pharmacy Cares
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Vibhudear's picture

Hello Devyani
Thank you very much for sharing such good informations. I m a lecturer by occupation and hadling Hospital pharmacy and for the lecture of the Patient Compliance i was jus searching something new and an apprapriate review. This information is quite helpfull for me thanx

regards:
Vibhor Kumar Jain
M.Pharm (Pharmaceutical chemistry)
+9410411583

Vibhor Kumar Jain M.Pharm (Pharmaceutical chemistry) +9410411583