DEFINITION BACKGROUND METHODS OF ASSESSING COMPLIANCE. Factors concerned with compliance. BARRIERS TO COMPLIANCE IMPROVEMENT OF COMPLIANCE . NON-COMPLIANCE FACTORS.

1. PATIENT COMPLIANCE
BY :
AMR FLIFLE

2.  DEFINITION
 BACKGROUND
 METHODS OF ASSESSING COMPLIANCE.
 Factors concerned with compliance.
 BARRIERS TO COMPLIANCE
 IMPROVEMENT OF COMPLIANCE .
 NON-COMPLIANCE FACTORS.

3. DEFINITION
PATIENT COMPLIANCE : The degree to which
the patient correctly follows medical advice;(medication, diet, smoking, or any
lifestyle change).
 PATIENT ADHERENCE .
 Drug compliance to dose, route, timing, and frequency . Moreover, device use, self-
care & therapy session or the follow-up.

4. Non-compliance
 Estimates from the World Health Organization (2003) indicate that only about
50% of patients with chronic diseases in developed countries follow treatment
recommendations
 Poor compliance sentiment that, since doctors can be wrong in their diagnoses,
their instructions are sometimes best ignored.
 Compliance is difficult to achieve in hypertensive patients who are asymptomatic
prior to the start of treatment the most affected.

5. Non-compliance associated with
Hypertension
 The epileptic, diabetic, or asthmatic will soon know about the dangers of poor drug
compliance, whereas the mild hypertensive may only realize its consequences after
months or years.
 In respect of anti-hypertensive therapy, only about 50% take at least 80% of their
prescribed medications.
 Resistant hypertension, raised blood pressure that does not respond to therapy with standard
drug treatment, may be the result of poor compliance.
 Hypertension non-compliance (93% in US, 70% in UK) is the main cause of
uncontrolled hypertension-associated heart attack and stroke.

6. Where to bin the blame ?!
 Patient or health-care provider ? Prof. Leslie (Harvard)

7. Methods of Assessing Compliance
Direct :
 Blood Level Monitoring (the drug itself, a drug metabolite, or a marker)
 Measurement of Urine Drug Excretion.
Indirect :
 Pill counts (non-complier may dispose of tablets instead of consuming).
 Questionnaires of Patients.
 Outcome of Therapy and Presence of Side Effects.(blood pressure).

8. Factors Associated with Noncompliance
 1-Patient Characteristics:
-(Weak relation) age, sex & economic status (strong).
 2-Disease Characteristics:
- long-term X short-term effect .
 3-Treatment Characteristics:
-The majority of treatment failures from non compliance occur within the first few
months.
-The simpler the drug regime , the more likely the patient is to comply.
 4-Doctor-Patient Relationship Characteristics.

9. Doctor-Patient Relationship
 The most important factor in patient compliance.
 Patients may stop drug treatment on their own initiative because of a
lack of understanding of the nature of disease and its treatment .
 Inefficiency of the medical service in recalling patients for follow-up.
 The medical practitioner is not aware of the need for long-term
treatment.
 Bad communication skills.

10. Barriers
 Complexity of medication.
 Lack of comprehension of treatment benefits.
 The occurrence of undiscussed side effects.
 The cost of prescription medicine.
 Doubting the need for medicine.
 Poor health literacy.
 Poor communication.

11. Improvement of compliance
 Recognition of the "At-Risk" Patient (chronic illness requiring long-term therapy,
and the ill effects of stopping)
 Treatment Planning (simple ,minimum number of drugs, Calendar packs &dose
dispensers)
 Explaining Treatment (To state that treatment will be "life long" is both potentially
discouraging & inaccurate ).
 Patient education.
 Social support.

12. conclusion
 Doctors should be aware of the problem of noncompliance
 Drug regimens should be kept as simple as possible .
 If a patient is not responding to treatment, investigation of the possibility of
noncompliance is mandatory.
 No doubt that a positive doctor-patient relationship is the most important factor
improving compliance.