Compliance in Treatment
PST 06102
:
Counselling and Guidance
Session 15
: Compliance in the Treatment
1
Learning tasks
At the end of this session, students are expected to be able to
:
Give introduction to compliance in the treatment
Describe importance of compliance in treatment
Explain reasons for non-compliance in the treatment
Explain methods of improving compliance
Explain methods of assessing compliance
2
Activity:
Buzzing
What is compliance in the treatment
?
3
Compliance in
Treatment
Is
filling up and complete an action or process and fulfilling the promise to a desirable, requested conditions specific to act in
conformity.
Compliance
can mean ‘accord agreement of amicable relations that has conformity.
Poor compliance to treatment of chronic diseases is a worldwide problem of striking magnitude., average of 50% in most diseases and excessive non-compliance accounts for a significant percent of admissions in patients with heart
failure
4
The consequences of poor compliance to long-term therapies are
poor
health outcomes and
increased
health care costs,
Increasing
the effectiveness of compliance interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments, a multidisciplinary approach towards compliance is needed
5
Types of patients based on the acceptance of diagnosis and treatment initiation, patients are categorized into four types
Non compliers
: those who do not accept diagnosis and need treatment.
Partial compliers
: those who accept diagnosis and treatment but cannot fulfill the recommended actions sufficiently to reach targeted improvements in their health.
Over compliers
: those who take recommended actions in excess of targeted improvements (these patients are rare).
Adequate compliers
: those who follow health advice adequately to improve or control their disorder
6
Importance of Compliance in Treatment
Taking your medicine as prescribed or medication adherence is important for
controlling
chronic conditions,
treating
temporary conditions, and
overall
long-term health and well-being.
A
personal connection with your health-care provider or pharmaceutical personnel is an important part of medication compliance
7
F
actors
determined to have the most important effect on patient compliance with dispensed
medications
Understanding of medical directions
Involvement in the Process
Compliance reminders
8
Activity:
Buzzing
What are the reasons for non-compliance in the treatment?
9
Non-compliance
in the Treatment
Non-compliance, failure or refusal to comply, in medicine, the term non-compliance is commonly used in regard to a patient who does not take a prescribed medication or follow a prescribed course of
treatment
A
person who demonstrates non-compliance is said to be non-compliant
10
Reasons for Non-compliance in the Treatment
a. The
nature of patient’s illness:
Patients
suffering from schizophrenia has high incidence of non-compliance, due to distorted reality & lack of insight do not recognize
their illness
and need for treatment, similarly in chronic disorders like hypertension, tuberculosis
etc
b. Therapeutic
regime:
Multiple
drug therapy like 5-6 prescribed drugs taking at different timings ,taking tablets with same color, size and shape cause more confusion and skip doses also technical difficulty in using inhalers
11
of treatment:
Compliance
is inversely proportional to duration of treatment, in a long term therapy, low compliance is observed as in bronchial asthma and hypertension
:
Increased
frequency of drug administration causes more disruption of normal routine or work schedule, hence many patients forget or inconvenienced or embarrassed
12
E. Adverse
events,
Some
patients are non-compliant due to adverse events. Some drugs like Anti-Hypertensive agents, Anti depressants or Anti psychotics cause sexual dysfunction which is frequently implicated for non compliance
F. Taste
of medication
,
Can
be the cause for noncompliance especially in children. Failure to comprehend the importance of therapy, as patient has limited knowledge about the illness, become non compliant if beliefs and expectations are not met with, poor understanding of instructions also contributes to non compliance
13
G
. Taste
of medication,
Can
be the cause for noncompliance especially in children. Failure to comprehend the importance of therapy, as patient has limited knowledge about the illness, become non compliant if beliefs and expectations are not met with, poor understanding of instructions also contributes to non compliance
14
Other Non compliance to treatment
Increased
, or decreased sensitivity to drugs,
Frequent change of prescriptions( prescription cascade),
Living alone,
Lack of social support system,
Difficulty in opening the medication container that has flip off type of lid
Going to pharmacist/chemist due to physical problems like (osteoarthritis)
Cognitive impairment,
Impaired mobility or dexterity,
Swallowing problems,
Financial issues like, Low income and high cost of medications,
Everyday inconvenience in carrying and taking of medicines
15
Methods of Improving Compliance
I
nclude
health
education to increase retention of the regimen,
self-monitoring
of medication habits,
tailoring
medication taking to other daily habits and
treatment
contracts
16
O
ther
methods
The patient can be supervised while taking the
drug
for
example, during treatment in hospital, by parents giving medicines to their children, visitors giving drugs to relatives, and a district pharmaceutical personnel giving medicines to elderly people
Single
dose treatment
eg
syphilis,
Improving the
palatability of
medicines
by
flavouring medicines for
children
Blister calendar
packs
for oral contraceptives or better blockers help p to remember to take the drug
.
17
By simplifying therapeutic regimens,
reducing
the number of tablets and reducing the frequency of
administration..
By educating the patient,
patient education on the nature of their condition and the necessity and aims of treatment
18
Methods of Assessing Compliance
Tablet
counting
Recording devices
Measuring the concentration of the drug in body fluids
Measuring the pharmacological effect
Measuring a marker substance added to the drug
19
Key
points
Compliance: Is filing up and complete an action or process and fulfilling the promise to a desirable, requested conditions specific to act in conformity,
Methods
to improve compliance to medication include
health
education to increase retention of the regimen,
self-monitoring
of medication habits,
tailoring
medication taking to other daily habits and
treatment
contracts,
20
Review questions
What are the reasons for non-compliance?
What are the important of compliance?
21
References
MoHSW (2005)
National guidelines for the clinical management of HIV and AIDS
, Dar
es
Salaam
.
Hubley
, J. (1993).
Communicating Health. An action and guide to health and health
Promotion.
1st Edition. British
Angotti
N, et al. (2009)
Increasing the acceptability of HIV counseling and testing with
three C’s: convenience, confidentiality and credibility. Thailand
MM,
Ostermann
J, Crump JA, (2010).
Characteristics of HIV voluntary counseling and testing clients before and during care and treatment scale-up
.Moshi, Tanzania.
Jones A. J (1951),
Principles of Guidance and Pupil Personal work
. New York. McGraw Hill
22
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