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:
Noncompliers: Those who do not accepts the diagnosis and need for treatment at this time.
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.
Over-compliers: Those who take more than the recommended amount of medication or who diet or exercise in excess (These patients are rare).
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.