Patient compliance

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Patient compliance is "voluntary cooperation of the patient in following a prescribed regimen."[1] Noncompliance is common 21942628 while improving compliance may improve health.[2]

Patient compliance is a component of health behavior.

Prevalence and epidemiology

"Primary nonadherence is common and may be reduced by lower drug costs and copayments, as well as increased follow-up care with prescribing physicians for patients with chronic conditions.". [3]

Among patients who have to take numerous drugs for their health (polypharmacy), not taking all of their medications may lead to poorer health outcomes.[4]

23% of patients report skipping doses or cutting pills in half to make their supply last longer according to one survey.[5] This is more common among low-income patients.

In a study of compliance over one year with medications for hypertension[6]

  • Half of the patients stopped taking a medicine completely (non-persistence)
  • 43% of patients took drug holidays in which they did not take a medication for three days or more (non-execution)

Patients are more likely to abandon prescriptions that are expensive.[7]

How to detect noncompliance

A systematic review by the Rational Clinical Examination concluded that missing appointment, not improving with treatment, and counting pills are the best methods to detect non-compliance.[8]

Methods to improve compliance

Dosing frequency and compliance
Doses per day  % of days in
compliance[9]
One 79
Two 69
Three 65
Four 51

Medications that are taken less often per day may be easier to comply with.[9][7][10] Fixed-dose combination drugs can help.[11][12] Similarly, polypharmacy should be avoided.

Reminders sent to patients, especially telephone calls, may improve compliance with vaccinations.[13]

References

  1. Anonymous (2015), Patient compliance (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. Wu JY, Leung WY, Chang S, et al (2006). "Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trial". BMJ 333 (7567): 522. DOI:10.1136/bmj.38905.447118.2F. PMID 16916809. Research Blogging.
  3. Tamblyn R, Eguale T, Huang A, Winslade N, Doran P (2014). "The incidence and determinants of primary nonadherence with prescribed medication in primary care: a cohort study.". Ann Intern Med 160 (7): 441-50. DOI:10.7326/M13-1705. PMID 24687067. Research Blogging.
  4. Simpson SH, Eurich DT, Majumdar SR, et al (2006). "A meta-analysis of the association between adherence to drug therapy and mortality". BMJ 333 (7557): 15. DOI:10.1136/bmj.38875.675486.55. PMID 16790458. Research Blogging.
  5. USA Today/Kaiser Family Foundation/Harvard School of Public Health Survey: the public on prescription drugs and pharmaceutical companies - kaiser family foundation. Retrieved March 10, 2008, from http://www.kff.org/kaiserpolls/pomr030408pkg.cfm.
  6. Vrijens B, Vincze G, Kristanto P, Urquhart J, Burnier M. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ. 2008 May 17;336(7653):1114-7. Epub 2008 May 14. PMID 18480115
  7. 7.0 7.1 Shrank WH, Choudhry NK, Fischer MA, Avorn J, Powell M, Schneeweiss S et al. (2010). "The epidemiology of prescriptions abandoned at the pharmacy.". Ann Intern Med 153 (10): 633-40. DOI:10.1059/0003-4819-153-10-201011160-00005. PMID 21079218. Research Blogging.
  8. Stephenson BJ, Rowe BH, Haynes RB, Macharia WM, Leon G (1993). "The rational clinical examination. Is this patient taking the treatment as prescribed?". JAMA 269 (21): 2779–81. DOI:10.1001/jama.1993.03500210079036. PMID 8492406. Research Blogging. pdf
  9. 9.0 9.1 Claxton AJ, Cramer J, Pierce C (2001). "A systematic review of the associations between dose regimens and medication compliance.". Clin Ther 23 (8): 1296-310. PMID 11558866[e]
  10. Treharne GJ, Lyons AC, Kitas GD (2005). "Adherence to medication". N. Engl. J. Med. 353 (18): 1972-4; author reply 1972-4. PMID 16270428[e]
  11. Pan F, Chernew ME, Fendrick AM (May 2008). "Impact of fixed-dose combination drugs on adherence to prescription medications". J Gen Intern Med 23 (5): 611–4. DOI:10.1007/s11606-008-0544-x. PMID 18288541. Research Blogging.
  12. Gerbino PP, Shoheiber O (June 2007). "Adherence patterns among patients treated with fixed-dose combination versus separate antihypertensive agents". Am J Health Syst Pharm 64 (12): 1279–83. DOI:10.2146/ajhp060434. PMID 17563050. Research Blogging.
  13. Szilagyi PG, Bordley C, Vann JC, Chelminski A, Kraus RM, Margolis PA et al. (2000). "Effect of patient reminder/recall interventions on immunization rates: A review.". JAMA 284 (14): 1820-7. PMID 11025835[e]