Patient compliance and assessment |Method of Assessment | Strategy to reduce patient non-compliance | Role of Pharmacist to Improve Patient Compliance

Prof. Shaikh Abusufiyan
Part-01:Patient Compliance
Pharma Learning

At the end of this e-learning session you are able to…
A. Define patient Non-compliance.
B. Discuss effect of poor compliance, method
of assessment and reasons for non-compliance.
2

l Safe and effective drug therapy occurs
when patients are well informed about
their medications and their use.
l Well inform patients exhibit:
- Increase compliance with drug regimens
Result in improved therapeutic outcomes

l Therefore, pharmacist and other health care professionals have a
responsibility --> to properly inform patients about their drug
therapy.
Non-compliance
l When patient does not follow the treatment schedule suggested
by the physician for the management of illness
he is described as non-compliant.

l Non compliant behaviour
also encompasses failure to obey instructions on:
- Diet
- Exercise
- Smoking or drinking habits.

l Degree of non compliance is expressed as a % of the ideal
compliance:
% compliance= NDP - NME * 100
NDP
l Where, NDP = No of doses prescribed
NME= No of medication error

Effect of Poor Compliance
l Poor compliance have serious effect in some
disease conditions:
- Non compliance with anticonvulsant therapy -->
contributes to uncontrolled seizures
- Omission of few doses of insulin --> may be life
threatening.
- Unintentional overdose result in --> toxicity,
serious enough to require hospitalisation.

Q&A
Q.1 When safe and effective drug therapy
occur?
Q.2 Enlist few effects of poor compliance.
8

Method of assessment of compliance
1. Interrogation:
l With the use of standard questionnaire:
- it is possible to assess the compliance
level and aspects such as:
- inconvenience of the regimen
- incidence of SE
- and overall level of comprehension.

2. Residual Tablet Counting:
- Tablet count can be performed on
regular basis and comparative no of
used tab over a period can be noted
down.
Disadvantage:
l Such methods are subjective and
inaccurate.

3. Urine analysis:
- Ex. Urine marker like riboflavin --> may be added in the
dosage regimen and its presence in the urine --> may be
noted for more accurate assessment of compliance.
4. Drug analysis:
- Specific and sensitive methods ----> to detect potent
therapeutic agent in body fluids, like digoxin and phenytoin.

l Cpss = F * D
Cl * T
l Cpss = Steady state concentration
F= Bioavailability
D= Dose administered
T= Dosage interval
Cl= Drug clearance

l The dose input rate (FD/T) may be
calculated as:
FD/T= Cpss * Cl
l Determination of plasma conc. of the
drug ---> give most accurate and
direct indication of the dose
administered.

Reference:
q Dr. H.P.Tipnis and Dr. Amrita Bajaj. Clinical Pharmacy, 3rd
edition. Carrier Publication Pg. No:86-105.

Q&A
Quiz-Attendance/Feedback:
https:/
/forms.gle/2zhTaYATheRTLQhG9
1
5

Pharma Learning

A. Explain the reason for patient Non-compliance.
B. Discuss strategies to overcome patient non-
compliance.
8

Reasons for Non-compliance
l The reason for non compliant behaviour --> are complex and cannot be generalised.
l Almost every patient --> is potential defaulter.
Reasons:
1. Poor standards of labelling:
- Label on medication containers must be clear and specific.
- Many patients do not understand common labelling instructions
ex. “Take as required” or “use as directed”
- Poorly hand written labels with bad hand writing are a major source of
medication error.

2. Inappropriate packing:
- Many elderly patients have difficulty
in opening the container --> specially
if size is too small or cap is difficult
to unscrew.
- The blister pack may be --> too rigid
- Glass bottle may be very fragile --->
making handling difficult

3. Complex therapeutic regimen:
- In case where patient have to take 25-30 different drugs at varying
time interval during day
Dosage regimens are difficult to memorize and lead to unintentional
non-compliance.

4. Nature of medication:
- Preparation with an unpleasant taste, colour or odour
- Extremely small tab ---> difficult to identify and handle
- Very large tab ---> difficult to swallow
- Liquid dosage form ---> difficult to transport
- Irritational side effect

5.Deliberate deviation:
- Once patient begin to feel better --> treatment may be stopped.
- Improper or insufficient advise --> given to patients
- At a time, lack of proper physician–pharmacist rapport
may also be responsible for non- compliant behaviour.

- Some time due to mental diseases -->
patient may forget to take an
occasional dose of medication.
- Doses may be completely omitted or
duplicated due to forgetfulness

Q&A
Q.1 Give one example of how poor standards of labelling
may be responsible for patient non-compliance?
Q.2 In which case patient non-compliance is due to
deliberate deviation?
5

Strategies for Improving Compliance
1. Simplification of the therapeutic regimen:
• Minimizing the complexity of therapeutic regimens
• Physician must prescribe a minimum number of drugs with well
define dosage schedules.
• Once daily dosage may be recommended whenever possible
(Sustained release, long acting oral preparation)

2. Improving standard of dispensing practice:
• Appropriate container size
can be selected
to accommodate a label, bearing dosage instructions

2. Improving standard of dispensing practice:
q Dosing Instructions must be:
• precise, explicit and large
• easily ridable
• Most satisfying container for elderly is palm
sized transparent bottle with standard soft
plastic screw cap.
• Child resistant containers should be used with
discretion.

3. Development of suitable
medication packaging:
- Packaging in general should help self
monitoring of drug intake.
- Ex. Blister or unit dose packaging

q Medication box: which is divided into
sections --> according to the days of the
week.
q Individual drugs are given in
compartments --> corresponding to the
time of administration. NEW START UP IDEA
https://www.dreamit.com/journal/fell
ow-launches-connected-pillbox

4. Supplementary Labelling:
q Supplementary labelling instructions --> are
recommended to convey important data
regarding drug administration.
q The information may include:
l Precaution or recommendation
l Description of drug action.

l Supplementary Labelling:
l Symbol or graphics --> may be used to
emphasise the correct time of
administration.
l A 'daily calendar' or a tablet
identification card --> bearing details of
the administration schedule may be given
to improve compliance.

Q&A
https:/
/forms.gle/sjRvLKEd9EUUV3466
3
4

Pharma Learning

A. Explain role of patient counselling for improving
patient compliance.
B. Demonstrate the knowledge of precautions, directions
for medications & administration instructions to improve
patient compliance.
7

Patient counselling and education
q The pharmacist should inform, educate
and counsel the patient about:
l Name
l Intended use and expected action
l Route, dosage form, administration schedule
l Special direction for preparation if any

l Precaution to be observed during administration
l Common SE
l Technique for self monitoring of drug therapy
l Storage
• Potential drug-drug or drug-food interaction
• Prescription refill information
• Action to be taken in the event of missed dose
• Selection of non prescription drug i.e OTC drug

l Depend on the type and extend of advice needed.
l It can be given in following forms:
1. Verbal counselling
2. Printed information including
o Warning card
o Individualised medication instruction sheets
o Leaflets and booklets describing drugs and
disease conditions
o Patient package insert given by manufacturer
The method of imparting patient education and counselling

3. In patient medication training program
4. Compliance clinics --> to educate patient
identified to be non-compliant.
l The pharmacist with good communication
skill and practical experience --> can
counsel the patients

q The routine counselling of all patients is
both undesirable and impractical.
q Priority should be given to cases where:
§ Prophylactic treatment
§ Drug with low safety margin (ex. Warfarin)
§ Premature withdrawal from treatment (ex.
Corticosteroids)
§ Long term therapy (for a chronic condition) (ex.
epilepsy)

Q&A
Q.1 Which information pharmacist impart to patient as
a part of patient counseling & education?
Q.2 What are different methods of imparting patient
education and counselling?
Q.3 In which case priority is given to patient
counselling?
3

Important think that is to be kept in mind???????
q Information should be conveyed in
a manner in which:
• The patient can understand and
comprehend.
• Common language and familiar term
should be used in a style which is
reassuring rather than threatening.

Precautions and Directions for Medications and
Administration Instructions
l It is to be conveyed to the patient by the Pharmacist.
IT WILL HELP TO
Reduce no of patients who do not take their prescribed
medication correctly

q Disease state:
• Type of counselling and degree of
instructions ----> influenced by the
particular disease state.
• Extend of counselling is depend on --->
the severity and risk factors.

q Attention should be drawn to:
l Precautions
l Indications and contraindications
l Adverse reactions
l Drug interaction
l And sign and symptoms to watch for promoting
safe use of drug

Ex. Diabetes patient must understand:
§ Important of maintaining treatment
schedule.
§ Proper diet and precaution in taking other
medicines.
§ Necessary storage precaution for the insulin
§ Need of sterile syringe.

q OTC products:
• Purchased even without consulting doctor.
• Pharmacist must help patient in selection of
OTC products
• Ex. Aspirin, Antacids and Vitamins

q Pharmacist must ensure their proper use by asking questions like:
§ “Are you aware that excessive use of
l antacids can lead to alkalosis?
l Laxative can lead to loss of intestinal tone?
• Or “if you are a cardiac patient”:
l do you know that high content of alkali is undesirable for your
condition and that you have to be on low salt diet?

q Printed drug information:
• Oral instructions are recommended to be
reinforced with additional printed information.
• Patient taking special categories of drugs
such as anti-coagulant and MAO inhibitors
should be given warning cards at the time of
dispensing

Q&A
https:/
/forms.gle/1mSf6hijNyRYmLD6A
5
3

Patient compliance and assessment |Method of Assessment | Strategy to reduce patient non-compliance | Role of Pharmacist to Improve Patient Compliance

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