What is compliance?
Therapeutic compliance: definition
The concept of compliance (or adherence to treatment) is defined by the fact that a patient follows the prescription given by the physician. It can be expressed by the ratio: number of medicines taken / number of medicines prescribed..
The causes of non-adherence to therapy and its consequences
There are multiple causes of non-adherence to a treatment. Amongst them is the over- or under-involvement of the physician and the pharmacist, response of the patient – as well as their individual characteristics (concomitant pathologies, psychiatric problems, etc.) – beyond the type of therapy as such.
A wide range of factors effectively contribute to the non-adherence to a treatment, mainly its
There are multiple causes of non-adherence to a treatment. Amongst them is the over- or under-involvement of the physician and the pharmacist, response of the patient – as well as their individual characteristics (concomitant pathologies, psychiatric problems, etc.) – beyond the type of therapy as such.
A wide range of factors effectively contribute to the non-adherence to a treatment, mainly its ccomplexity, duration, prior failures, frequent modifications in the treatment schedule, absence of immediate clinical improvement and occurrence of effects.
Several studies show that adherence to the treatment progressively decreases as the complexity (number of medicines, and number of daily doses) and the duration of the prescribed treatment schedule increases. The patients experience practical difficulties – understanding the dosage, remembering the doses to be taken and their timings, identifying the different tablets (size, colour, etc.), as well as difficulties with the packaging.
Given that adherence to the medical treatment determines its success, non-adherence to the treatment, especially in the case of chronic diseases, leads to aggravation of the illnesses further leading to new medical expenses, additional diagnosis, hospitalisation and medical consultations, which in turn lead to an increase in absenteeism, decrease in productivity, as well as an increase in premature deaths and the number of disabled people.
Poor compliance is thus a major problem of public health and constitutes a problem of additional costs for public authorities.s.
Therapeutic education is necessary to modify the patients behaviour and improve the effectiveness of treatments
It is estimated that, in developed countries, 1 of every 2 patients suffering from chronic diseases does not follow his/her treatment properly (forget to take medicines, delay in taking medicines, etc.):
50% of the patients change their medical prescriptions
21% change the prescribed therapeutic doses
36% change the duration of treatment
The problem of non-adherence to a treatment is observed in all situations where the treatment is self-administered, whatever the type of disease and the quality and/or accessibility to the health system.
Non-compliance results from several factors :
Factors related to the patient :
- Age (e.g. adolescence is a difficult period)
- Denial of illness
- Poor understanding of the necessity of the treatment: Why is it necessary to take treatment even after the crisis ends?
- Lack of confidence in one’s physician that most often leads to medical nomadism
- Absence of quick improvement of the symptoms
- Beliefs and representations of the illness: fatality, injustice, etc.
Factors related to the disease :
- Compliance reduces with time
- Once the medical crisis ends, the patient feels alright and stops his/her treatment
Factors related to the treatment :
- Fear of adverse effects of the medicines
- Complex treatments
- Routine of the treatment (weariness)
- Daily multiple prescribed doses
Factors related to the physician :
- Poor physician/patient communicationnt
- Extremely short consultation period (lack of time).
This poor compliance leads to an increase in morbidity, with a decrease in the effectiveness of the treatments and an increase in work stoppages or absences from school. In addition, 30% of hospitalisations of persons aged more than 70 years are due to errors in taking their medication.
According to WHO (World Health Organization)
Not following a medical treatment is a global problem, which increases parallel to the global weight of the illness. Improper adherence to therapy leads to negative results in the health indicators and an increase in health-related expenses.An increase in the level of adherence to the medical treatment of the individual patient culminates in an increase in his/her level of safety.
To this effect :
- The patients should be helped and not criticised.
- The interventions should be personalised for each patient (there is no one particular strategy that would prove effective for all the patients and illnesses).
- The health professionals and health systems should bring about the change.
- The health professionals need specific training.
- The family, health care organisations and the general community are key factors in the improvement of therapeutic adherence, which highlights the importance of a multidisciplinary approach.
Two main intervention strategies are identified to increase the level of adherence to the medical treatment: educational strategies (carry information) and behavioural strategies. These include increasing communication and advice, simplifying treatment schedules, involving patients in their treatment,the use of pill boxes, etc.
