ADHERENCE (COMPLIANCE)

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					  ADHERENCE
 (COMPLIANCE)
  Kai-Lit Phua, PhD FLMI
    Associate Professor
School of Medicine & Health
          Sciences
Monash University Malaysia
           Biographical Details

Kai-Lit Phua received his BA (cum laude) in Public Health
& Population Studies from the University of Rochester
and his PhD in Sociology (Medical Sociology) from Johns
Hopkins University. He also holds professional
qualifications from the insurance industry.

Prior to joining academia, he worked as a research
statistician for the Maryland Department of Health and
Mental Hygiene and for the Managed Care Department
of a leading insurance company in Singapore.

He was awarded an Asian Public Intellectual Senior
Fellowship by the Nippon Foundation in 2003.
            NONADHERENCE
This simply means failure of a patient to follow
  medical instructions and advice

EXAMPLES:
 Patient does not take his or her medicine at all
 Improper dosages are taken
 The medicine is taken along with unprescribed
  drugs (including traditional medicine). This can
  lead to adverse interactions.
 Not following advice on nutrition e.g. during
  pregnancy and lactation
          NONADHERENCE
Nonadherence is widespread (some
 estimates go as high as 50%!)

The consequences can be serious e.g.
 diabetes mellitus, hypertension
          FACTORS AFFECTING
            NONADHERENCE
   Personality of the patient e.g. some patients like
    to “rebel against authority”, denial of disease
   Poor quality of doctor-patient interaction
   Cognitive factors e.g. forgetting, unclear
    instructions, too complex medications, careless
   Uncomfortable side effects
   Drugs are too expensive (patient tries to
    “stretch” the medicine by skipping a dose)
   Patient frustration with being dependent on drug
   “Testing” by the patient
    Food taboos and beliefs – sickness, pregnancy,
    lactation, menstruation
           STEPS TO IMPROVE
              ADHERENCE
   Give clear and simple instructions
   Better doctor-patient communication and
    interaction (emphasise, repeat, be specific, etc.)
   Simplify the regimen if possible
   Prescribe cheaper generic drugs in place of
    expensive, branded drugs
   Inform patient about possible side effects
   Change the medication if severe side effects
   Explain about taking antibiotics properly
   Get family members to monitor adherence
    Doctor can also monitor adherence
   Deal with food taboos and beliefs
                REMEMBER!
Partial adherence is better than total
  nonadherence

Important to educate patients about taking
  antibiotics properly i.e. take the entire course

Be especially careful when prescribing to children,
  the elderly, and the immunocompromised

Look out for serious side effects, adverse reactions
  and adverse interactions!
THE END




   THANK YOU

				
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