Medication Noncompliance
Medication Compliance
Medication Compliance
Medication compliance is the "act of taking medication on schedule or taking
medication as prescribed."
Medication adherence is defined as “the extent to which a patient adheres to the
prescribed dose and interval of their medication regimen.”
Patient compliance with prescribed and non-prescribed medications is defined
as patient understanding and adherence to the directions for use. The compliant
patient follows the directions for taking the medication properly and adheres to
any special instructions provided by the prescriber and/or pharmacist.
Patients are considered adherent to their medication when the number of pills
absent in a given period divided by the number of pills prescribed by the
physician in that same period is greater than 80%.
One can miss almost a week of medication during a month and still be
considered adherent.
Medication Compliance
Medication Compliance
Approximately 117 million Americans live with at least 1 or more chronic
diseases, often requiring multiple lifelong medications for control.
Improving medication adherence may have a greater influence on the health
of the population than in the discovery of any new therapy.
Effective medicines are available for many conditions and yet patients are
nonadherent to their medicine 50% of the time. In certain disease states,
potentially asymptomatic conditions such as hypertension, the incidence may
approach 80%.
Patient-related factors have a greater influence predicting adherence than
provider-related or payment-related variables.
Although most physicians believe nonadherence is due to lack of access or
poor memory, it is often an intentional choice by the patient.
Critical predictors of adherence are trust, understanding and provider-patient
relationships, which are absent from current databases.
>>Improving medication adherence is the “next frontier in quality
improvement”.
Noncompliance
Patient noncompliance occurs when a patient does not adhere to their
treatment plan.
Whether it’s prescribed medication, a treatment regimen, or another lifestyle
adjustment, they just won’t do it. Or they won’t do it enough.
It's beyond frustrating when, no matter how great your treatments are, your
patients just won't stick to them. A medication is only as good as its use, after
all.
We’ve all been there. It’s hard to help someone who doesn’t want to be
helped.
Noncompliance
There are few things more frustrating for us optometrists than a noncompliant
patient.
You offer them a treatment plan that will relieve their symptoms or even cure
their condition, and they come back to you complaining that they aren’t
seeing results.
With a little probing, they tell you that they stopped using their eye drops. Or,
they haven't been using their medication according to your dosage schedule.
>> Even worse, they think that the treatment options you gave them are all
pointless and a waste of time and/or money.
However, delving into the psychology of patient noncompliance can provide
some useful insights into how to break through that barrier and help your
patients help themselves.
Consequences of Noncompliance
Medication nonadherence leads to poor outcomes, increasing healthcare
service utilization and overall healthcare costs.
Nonadherence to cardiovascular medications has been associated with
increased risks of morbidity and mortality.
Medication nonadherence is estimated to lead to between $100 and $300
billion of avoidable healthcare costs in the United States annually,
representing 3–10% of total U.S. healthcare costs.
Nonadherence to medication is often hidden. The critical first step in
improving adherence is uncovering its presence.
Study reported that 83% of patients would never tell a provider that they were
not going to fill a new prescription, although providers estimated only 9%
would withhold such information.
Method of Noncompliance Assessment
Assessment of noncompliance is a necessary prerequisite for adequate
treatment.
Noncompliance can be detected by:
Indirect methods
Self-report
Interview
Therapeutic outcome
Pill count
Electronic medication monitoring
Physician ordering in electronic health records (EHRs)
Direct methods
Biologic markers
Tracer compounds
Biologic assay of body fluids
In general, the direct methods of detection have a higher sensitivity and
specificity than the indirect methods.
Method of Noncompliance Assessment
Electronic medication monitoring and physician ordering in electronic health
records (EHRs) are the most recent and reliable of the indirect-detection
methods.
Strategies for improving compliance involve
Identification of risk factors for non-compliance
Development, with the patient's participation, of an individualized treatment
plan that simplifies the regimen as much as possible
Education of the patient, including information about his or her illness
Instructions on how to take the prescribed medication correctly
An explanation of the benefits and possible adverse effects of the therapy
Use of compliance aids such as medication calendars, special containers,
caps, and dispensing systems, or compliance packaging.
Dimensions of Noncompliance
