called adherence) is the extent to which patients follow treatment
instructions. There are four types of noncompliance leading to medication
1. The patient fails
to obtain the medication. Some studies sug-gest that one third of patients
never have their prescriptions filled. Some patients leave the hospital without
obtaining their discharge medications, whereas others leave the hospital
without having their prehospitalization medications resumed. Some patients
cannot afford the medications prescribed.
patient fails to take the medication as prescribed. Examples include wrong
dosage, wrong frequency of administration, improper timing or sequencing of
administration, wrong route or technique of administration, or taking
medication for the wrong purpose. This usually results from inadequate
communication between the patient and the prescriber and the pharmacist.
3. The patient
prematurely discontinues the medication. This can occur, for instance, if the
patient incorrectly assumes that the medication is no longer needed because the
bottle is empty or symptomatic improvement has occurred.
4. The patient (or another person) takes medication inappropri-ately. For example, the patient may share a medication with others for any of several reasons.
Several factors encourage noncompliance. Some diseases cause no symptoms (eg, hypertension); patients with these diseases therefore have no symptoms to remind them to take their medica-tions. Patients with painful conditions such as arthritis may con-tinually change medications in the hope of finding a better one.Characteristics of the therapy itself can limit the degree of compliance; patients taking a drug once a day are much more likely to be compliant than those taking a drug four times a day. Various patient factors also play a role in compliance. Patients living alone are much less likely to be compliant than married patients of the same age. Packaging may also be a deterrent to compliance—elderly arthritic patients often have difficulty opening their medication containers. Lack of transportation as well as various social or personal beliefs about medications are like-wise barriers to compliance.
for improving compliance include enhanced com-munication between the patient
and health care team members; assessment of personal, social, and economic
conditions (often reflected in the patient’s lifestyle); development of a
routine for taking medications (eg, at mealtimes if the patient has regular
meals); provision of systems to assist taking medications (ie, containers that
separate drug doses by day of the week, or medica-tion alarm clocks that remind
patients to take their medications); and mailing of refill reminders by the
pharmacist to patients tak-ing drugs chronically. The patient who is likely to
discontinue a medication because of a perceived drug-related problem should
receive instruction about how to monitor and understand the effects of the
medication. Compliance can often be improved by enlisting the patient’s active
participation in the treatment.