ADHERENCE (COMPLIANCE)

1
ADHERENCE (COMPLIANCE)

• Kai-Lit Phua, PhD FLMI
• Associate Professor
• School of Medicine Health Sciences
• Monash University Malaysia

2
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.

3
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

4
NONADHERENCE

• Nonadherence is widespread (some estimates go as
  high as 50!)
• The consequences can be serious e.g. diabetes
  mellitus, hypertension

5
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

6
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

7
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!

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THE END
THANK YOU