Information about Compliance (medicine)

Compliance (or Adherence) in a medical context refers to a patient both agreeing to and then undergoing some part of their treatment program as advised by their doctor or other healthcare worker. Most commonly it is whether a patient takes their medication (Drug compliance), but may also apply to use of surgical appliances (e.g. compression stockings), chronic wound care, self-directed physiotherapy exercises, or attending for a course of therapy (e.g. counselling).

A patient may or may not accurately report back to their healthcare workers whether they have been compliant because of possible embarrassment, fear of being chastised or for seeming to be ungrateful for their doctor's care.

Causes for poor compliance include:^[1]

• Forgetfulness
• Prescription not collected or not dispensed
• Purpose of treatment not clear
• Perceived lack of effect
• Real or perceived side-effects
• Instructions for administering not clear
• Physical difficulty in complying (e.g. with opening medicine containers, handling small tablets or swallowing difficulties, travel to place of treatment)
• Unattractive formulation (e.g. unpleasant taste)
• Complicated regimen
• Cost of drugs

Adherence

It has been estimated that half of those for whom medicines are prescribed do not take them in the recommended way. Until recently this was termed "non-compliance", which was sometimes regarded as a manifestation of irrational behavior or willful failure to observe instructions, although forgetfulness is probably a more common reason. But today, health care professionals prefer to talk about "adherence" to a regimen rather than "compliance".

There have been many studies of the effects of different strategies in improving adherence to therapy. These include reducing the frequency of administration during the day and reducing the numbers of medicines the patient has to take. However, evidence that such measures are effective is lacking.

Nevertheless, it seems likely that adherence can be improved by taking care to explain the benefits and adverse effects of a drug; in a busy clinic it is all too easy for the prescriber to issue a prescription with little or no explanation. Reducing the frequency of administration to once, or, at most, twice a day also makes sense, despite lack of convincing evidence that this is effective.

Drug compliance

It has been estimated that in developed countries only 50% of patients who suffer from chronic diseases adhere to treatment recommendations.^[2] This may affect the patient's own immediate health or have implications for the wider society (e.g. failure to prevent complications from chronic diseases, formation of resistant infections or untreated psychiatric illness). There are also important implications when assessing reports from research into treatment efficacy rates, given that compliance rates during closely monitored studies are usually far higher than in later real-world situations (e.g. up to 97% compliance in some studies on statins, but only about 50% of patients continue at six months).^[3] Special attention should be paid to the fact that the word “adherence” is preferred by many health care providers, because “compliance” suggests that the patient is passively following the doctor’s orders and that the treatment plan is not based on a therapeutic alliance or contract established between the patient and the physician. According to some, both terms are imperfect and uninformative descriptions of medication-taking behavior.^[4]

Prescription collection and dispensing

In the past there was an expectation, by both doctors and patients, that the end of consultation should be marked by prescribing some form of medication to treat the problem. However many patients merely seek reassurance as to the nature of their symptoms, rather than necessarily wishing to commence a course of treatment. It has been estimated that up to a third of prescriptions written by UK GPs are not later presented to a pharmacist for dispensing. Likewise a similar fraction of all medication dispensed is not taken in accordance with the prescribing instructions.

Failure to present a prescription for dispensing may reflect forgetfulness by a patient, or belief that reassurance or some other self-care measures rather than medication was required. Alternatively a patient may believe that their condition does not yet warrant starting treatment but that they now have a prescription ready should the problem either deteriorate or fail to resolve spontaneously. This last point is particularly important for those unable to return to their doctor should their condition change; whether through difficulty taking time off from work to revisit their doctor, it being just prior to a weekend when their doctor's surgery may be closed, or prior to undertaking long journeys away from home.

For conditions such as earache or sore throat that Evidence based medicine suggests do not automatically require a course of antibiotics, it is becoming increasingly common for doctors to issue deferred prescriptions. These are intentionally not to be dispensed for a specified period of time unless the patient feels that spontaneous recovery is not occurring. It has been estimated that only about a third of deferred prescriptions are made use of, and this provides a useful means of reducing unnecessary antibiotic prescribing without antagonising patients in the western world who through cultural, the wider media and past medical practices may have unrealistic expectations on the value of antibiotics for minor common illness.

Course completion

Once started, patients often fail to adhere to the original prescribing instructions either over dosage frequency or completion of the course. Medication that must be taken several times a day causes practical difficulties for patients including remembering to take, having to carry around the medication with them, availability of water to help swallow tablets. If a course of treatment proves effective, then the imperative to continue with the effort of taking the medication in order to relieve symptoms is lost and many patients therefore stop at this point. This may result in only an incomplete cure being achieved with a risk of relapse or, in the case of treating infections, lead to the development of antibiotic resistance. Failure to comply with completion is more likely if the patient experiences troublesome side effects, has concerns for the long-term effects of their treatment, or if medication must be taken for a protracted period. This is a greater problem therefore with any long-term treatment particularly if the medication merely stabilises a condition rather than gives relief from symptoms. Furthermore there are wider implications to society if a patient fails to comply with treatment for a number of conditions:

• Communicable diseases such as tuberculosis or HIV present a risk to society should a patient fail to comply with treatment thus resulting in the development of resistant strains, that may prove incurable.
• Patients with some psychiatric illness, such as schizophrenia or bipolar disorder, may feel entirely well whilst stabilised on medication, but are at risk of relapse should they discontinue.
• Patients taking certain antihypertensive medications may experience severe high blood pressure if they discontinue the medication abruptly. This is known as rebound hypertension.
• Corticosteroids may require a gradual reduction in dose if taken long-term. If the medication is discontinued abruptly, the body does not have sufficient time to adjust, and the patient may develop adrenal insufficiency as a result.
• Anticonvulsant drugs can have unpleasant side effects, such as interfering with abstract thinking. For most people, this is not a serious problem, because most people do little abstract thinking. For some professionals—such as doctors, lawyers, and writers—this is a disabling condition that makes it impossible to work. In some cases, a patient will report that the drug makes him/her "feel stupid" and then stop taking it: typically, the patient subsequently will have seizures. There is one known case, on June 24, 1996, of a non-compliant epileptic's having a seizure behind the wheel of his car, causing a fatal head-on collision on the Golden Gate Bridge, as reported in the San Francisco Chronicle for June 25, 1996.

Concordance

Concordance is an approach at involving the patient in the treatment process to improve compliance and is a current UK NHS initiative.^[5] The patient, being informed about the condition and the various treatment options, is jointly involved in the decision as to which course of action to take and partially responsible for the monitoring and reporting back to others involved in their care. Compliance with treatment is improved by:

• Only recommending treatments that are effective in circumstances when they are required
• Selecting treatments with lower levels of side effect or concerns for long-term use
• Prescribing the minimum number of different medications, e.g. prescribing for someone with two concurrent infections a single antibiotic that addresses the sensitivities of both likely bacteria, rather than two separate courses of antibiotics. However, this also raises the spectre of developing antibiotic resistant species in the wider scenario.
• Simplifying dosage regimen, whether by selecting a different drug or using a sustained release preparations that need less frequent dosages during the day.^[6]
• Explanation of possible side effects and whether important to continue with the course of medication none-the-less.
• Advice on minimising or otherwise coping with side effects, e.g. advice on whether to take a particular drug on an empty stomach or with food.
• Developing trust between the patient and their doctor such that patients do not feel they will be embarrassed or seen as ungrateful if they are unable to take a particular drug, thus allowing a better tolerated alternative preparation to be tried.

See also

• Medical error
• Pill burden
• Polypharmacy
• Withdrawal

References

patient is any person who receives medical attention, care, or treatment. The person is most often ill or injured and in need of treatment by a physician or other medical professional.
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A chronic wound is a wound that does not heal in an orderly set of stages and in a predictable amount of time the way most wounds do; wounds that do not heal within three months are often considered chronic.
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The statins (or HMG-CoA reductase inhibitors) form a class of hypolipidemic agents, used as pharmaceutical agents to lower cholesterol levels in people with or at risk of cardiovascular disease.
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Motto
"Dieu et mon droit" ^[2]   (French)
"God and my right"
Anthem
"God Save the Queen" ^[3]
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A general practitioner (GP), family physician or family practitioner (FP) is a medical doctor who provides primary care. A GP/FP treats acute and chronic illnesses, provides preventive care and health education for all ages and both sexes.
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Otitis media
Classification & external resources

ICD-10 H65-H67
ICD-9 381 - 382

eMedicine EMERG/351   Otitis media is inflammation of the middle ear: the small space between the ear drum and the inner ear.
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Pharyngitis
Classification & external resources

Viral pharyngitis.
The oropharynx is swollen and red.
ICD-10 J 02. , J 31.2
ICD-9 462 , 472.1

DiseasesDB 24580
MedlinePlus 000655
eMedicine emerg/419  
MeSH D010612
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Evidence-based medicine (EBM) or scientific medicine is an attempt to apply more uniformly the standards of evidence gained from the scientific method to certain aspects of medical practice.
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antibiotic is a chemotherapeutic agent that inhibits or abolishes the growth of micro-organisms, such as bacteria, fungi, or protozoans. The term originally referred to any agent with biological activity against living organisms; however, "antibiotic" now is used to refer to
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Antibiotic resistance is the ability of a microorganism to withstand the effects of an antibiotic. It is a specific type of drug resistance. Antibiotic resistance evolves naturally via natural selection through random mutation, but it could also be engineered.
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Editing of this page by unregistered or newly registered users is currently disabled due to vandalism.
If you are prevented from editing this page, and you wish to make a change, please discuss changes on the talk page, request unprotection, log in, or .
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Human immunodeficiency virus 1
• Human immunodeficiency virus 2
  

International Statistical Classification of Diseases and Related Health Problems Codes
Classification & external resources

ICD-10 B20-B24
ICD-9 042 - 044
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Schizophrenia
Classification & external resources

Eugen Bleuler (1857–1939) coined the term "Schizophrenia" in 1908
ICD-10 F 20.
ICD-9 295

OMIM 181500
DiseasesDB 11890
MedlinePlus 000928
eMedicine med/2072   emerg/520


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MeSH D001714

Bipolar disorder is a psychiatric condition defined as recurrent episodes of significant disturbance in mood. These disturbances can occur on a spectrum that ranges from debilitating depression to unbridled mania.
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Antihypertensives are a class of drugs that are used in medicine and pharmacology to treat hypertension (high blood pressure). There are many classes of antihypertensives, which—by varying means—act by lowering blood pressure.
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Hypertension
Classification & external resources

ICD-10 I 10. ,I 11. ,I 12. ,
I 13. ,I 15.
ICD-9 401.x

OMIM 145500
DiseasesDB 6330
MedlinePlus 000468
eMedicine med/1106   ped/1097 emerg/267

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Rebound hypertension is high blood pressure associated with sudden withdrawal of various antihypertensive medications. The increases in blood pressure may result in blood pressures greater than when the medication was initiated.
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Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood
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MeSH D000309 In medicine, adrenal insufficiency (or "hypocortisolism") is the inability of the adrenal gland to produce adequate amounts of cortisol in response to stress. See also: Adrenal Fatigue or Hypoadrenia.
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The anticonvulsants, sometimes also called antiepileptics, belong to a diverse group of pharmaceuticals used in prevention of the occurrence of epileptic seizures. More and more, anticonvulsants are also finding ways into the treatment of bipolar disorder, since many seem to
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head-on collision is one where the front ends of two ships, trains, planes or vehicles hit each other, as opposed to a side-collision or rear-end collision.

Rail transport

With rail, a head-on collision often implies a collision on a single line railway.
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Golden Gate Bridge is a suspension bridge spanning the Golden Gate, the opening into the San Francisco Bay from the Pacific Ocean. It connects the city of San Francisco on the northern tip of the San Francisco Peninsula to Marin County as part of US Highway 101 and California State
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The 2005-07-27 front page of
"The Voice of the West"
Type Daily newspaper
Format Broadsheet

---

Owner Hearst Communications
Publisher Frank J. Vega
Editor Phil Bronstein
Founded 1865
Price US$ 0.46 + tax Daily
US$ 1.
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Motto
"Dieu et mon droit" ^[2]   (French)
"God and my right"
Anthem
"God Save the Queen" ^[3]
..... Click the link for more information.

Antibiotic resistance is the ability of a microorganism to withstand the effects of an antibiotic. It is a specific type of drug resistance. Antibiotic resistance evolves naturally via natural selection through random mutation, but it could also be engineered.
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Sustained-release (SR), extended-release (ER, XR, or XL), time-release or timed-release, controlled-release (CR), or continuous-release (CR or Contin
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worldwide view.

See also preventable medical errors

In the United States medical error is estimated to result in 44,000 to 98,000 unnecessary deaths and 1,000,000 excess injuries each year.^[1][2].
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Pill burden is a term that refers to the number of tablets, capsules or other dosage forms that a patient takes on a regular schedule.

Higher pill burden decreases compliance with drug therapy, due to the need to take a large quantity of pills on a regular basis.
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The term polypharmacy generally refers to the use of multiple medications by a patient. The term is used when too many forms of medication are used by a patient, more drugs are prescribed than clinically warranted,^[1]
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For other meanings, see Withdrawal (disambiguation).

Withdrawal, also known as withdrawal syndrome, refers to the characteristic signs and symptoms that appear when a drug that causes physical dependence is regularly used for a long time and then
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