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Compliance (or Adherence) in a medical context refers to a patient agreeing to and then undergoing some part of a treatment program as advised by a doctor or other healthcare worker. Most commonly it is a patient taking medication (drug compliance), but may also apply to use of surgical appliances such as compression stockings, chronic wound care, self-directed physiotherapy exercises, or attending counselling or other courses of therapy.
Patients may not accurately report back to healthcare workers because fear of possible embarrassment, being chastised, or seeming to be ungrateful for a doctor's care.
Causes for poor compliance include:
Additional recommended knowledge
An estimated half of those for whom medicines are prescribed do not take them in the recommended way. Until recently this was termed "non-compliance", and 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 a patient has to take. However, there is no evidence that such measures are effective.
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 too easy for the prescriber to give out a prescription with little or no explanation. It also makes sense to reduce the frequency of taking medicine to once or twice a day: though again, there is no evidence that this tactic is effective.
It is estimated that only 50% of patients suffering from chronic diseases in developed countries follow treatment recommendations. This may affect the health of the patient, as well as that of the wider society when resulting in complications from chronic diseases, formation of resistant infections, or untreated psychiatric illness. Compliance rates during closely monitored studies are usually far higher than in later real-world situations: for example, there may be up to 97% compliance in some studies on statins, but only about 50% of patients continue at six months. Again, the word “adherence” is preferred by many health care providers, because “compliance” suggests that the patient is passively following the doctor’s orders. Patients should not be passive: a treatment plan must be based on a therapeutic alliance or contract between the patient and the physician. Yet at least one reference implies that both terms are flawed, giving no meaningful information. 
Prescription collection and dispensing
In the past both doctor and patient expected that the end of a consultation should be marked by a prescription. However, many patients don't necessarily wish to commence a course of treatment, but merely seek reassurance as to the nature of their symptoms. It has been estimated that up to a third of prescriptions written by UK GPs do not go to the pharmacist. A third of all dispensed medication is not taken in accordance with the prescribing instructions.
Patients may simply forget to bring the prescription to a pharmacist. They may believe that the medication was not needed: the consultation provided reassurance, or pointed the way to self-care measures other than medication. Some patients may alternatively believe that their condition does not yet warrant starting treatment, but that the prescription is only in place should the problem fail to resolve spontaineously or deteriorate. Some of these patients are later unable to return to their doctor when their condition changes.
Conditions such as earache or sore throat do not automatically require a course of antibiotics. Evidence based medicine supports the increasingly common writing of 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. Only about a third of deferred prescriptions are used, which reduces unnecessary antibiotic use without antagonising patients.
Once started, patients seldom take their medicines as often as they should, and seldom complete the course of medication. It is often practially difficult for a patient to remember to take medication several times a day. He or she may forget, not have the dose at hand, or have no water to help swallow tablets. If a course of treatment works, then the patient may feel that no more medication is needed -- the symptoms are gone, after all -- and thus stop prematurely. Their cure is incomplete. He or she might stop medication prematurely after experiencing troublesome side effects, or after concerns of the long-term effects of a treatment. Still others quit when medication be taken for a long time. The risk of a patient quitting a long-term treatment grows greater when that treatment stablizes a condition, rather than giving relief from symptoms.
Patients who quit their medication take risks. Some may relapse. Others, who were taking antibiotics after an infection, thus make it possible for an infection to survive with antibiotic resistance. These patients also create risks for the rest of society:
Concordance is a current UK NHS initiative to involve the patient in the treatment process and so improve compliance. The patient is informed about his or her condition and its various treatment options. He or she is involved with the treatment team in the decision as to which course of action to take, and partially responsible for monitoring and reporting back to the team. Compliance with treatment is improved by:
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Compliance_(medicine)". A list of authors is available in Wikipedia.|