Download Compliance (Medical sociology)

Compliance (Medical sociology)
1. Identify causes of non-compliance in patients with chronic illness.
2. Discuss the factors that contribute to compliance & non-compliance with treatment.
Compliance: the process of complying with a regimen of treatment consistently and accurately.
Compliance is often an indicator of the doctor-patient relationship. Non-compliance may be
intentional or unintentional as the result of a communication breakdown.
Non-compliance may be due to:
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A poor doctor:patient relationship resulting in the patient feeling they cannot/should not
ask the doctor questions, and hence reject the treatment or even the diagnosis, without
communicating this.
A patient’s lack of knowledge and understanding of the importance of treatment and/or
medications, and their appropriate use.
The patients self-diagnosis through own research (friends, internet) leads them to noncompliance or additional conflicting treatments.
Concern by the patient over possible or experienced side effects and dependency issues.
Disagreement with components or the whole of, the diagnosis and treatment, or the
outcome and effects of these.
Requirement for behavioural changes, eg diet or smoking, that do not seem to have an
immediately tangible connection (ability to integrate into daily life).
A patient’s unresolved concern associated with a negative attitude towards the use of
treatments such as drugs.
A patient feels they are ok and do not need to continue medication, also asthmatics who
haven’t had an attack for a while feel they are ok & stop taking their preventer.
They would rather die than keep putting up with the regime they have.
The treatment is painful
Forgetfulness, and age-related issues
High cost, and regular nature of the cost
Diagnosing poor compliance can be difficult and requires an open, non-judgmental exploration
with the patient about pill-taking habits. Physicians may preface this discussion by
acknowledging that pills are expensive, symbolic of illness, sometimes accompanied by
unpleasant side effects, and can be difficult to take as prescribed, to reassure the patient.
Although having a chronic illness can cost a lot of money both to the individual and the
community in treatment, people who fail to comply end up with greater cost due to there
continual relapses and falling into medical treatment. This lays a burden on both the hospital and
the community in taking up unnecessary hospital beds and the cost of being there.
Economic costs:
increased absenteeism
lost productivity at work
lost revenues to pharmacies / pharmaceutical manufacturers
more visits to practitioners
progression of disease to fuerther stages
The ethical question that arises is does the person have to comply to these costs or does the
person have the right to choose not to take the treatment, and the burden they lay on the
community?
Drug related issues:
o Over or under use, wrong time
o Taking the wrong medicine
o Not finishing medication
o Administration errors
o Using another persons medication
o Using old, possibly expired medication
Patients at higher risk:
 Asymptomatic conditions
o hypertension
 Chronic conditions
o hypertension, arthritis, diabetes
 Cognitive impairment
o dementia, Alzheimers
 Complex regimens
o poly pharmacy
3. Outline the reasons why chronic disease management is often sub-optimal in Aboriginal
populations.
Compliance is an important issue for the health of the Aboriginal people. The word implies
that patients are not following the doctor’s ‘rules’. In the Aboriginal context, ‘concordance’ may
be a better concept to describe both doctor and patient working together in ‘harmony and
agreement’. This creates the environment to gain cooperative and successful goals, with less
implied heirachy.
The ‘ethnocentrism’ of the doctor can be a barrier to concordance, where there is a lack of
appreciation for the wholistic role that health care plays in Aboriginal culture. Additional factors
that may play a role:
Health literacy of the patient,
Access to health care
Education of benefits
Cost to patients
Health professionals resisting working in high-need areas
Requirement for ongoing treatment, incl travel to clinics, etc
Lifestyle limitations required to reduce conditions where disease can flourish
This is a really good article, specific to the topic:
http://www.racgp.org.au/afp/200510/200510benson.pdf
4. Identify strategies to increase compliance with treatment in Aboriginal and nonAboriginal people.
In the context of Aboriginal health a more ‘patient centred’ model of the doctor-patient
interaction is needed. General practitioners should not to have a pessimistic attitude toward these
issues, & identify ways in which the best possible results can be achieved.
Methods to improve compliance:
 Patient education. Clearly communicate objectives and discuss the consequences and the
benefits of treatment. Emphasize that treatments may not always have immediate results but
are aimed at preventing morbidity and ultimately mortality and are therefore necessary.
Discuss, demonstrate and watch the patients repeat treatment where applicable. Be open
about the natural tendency for denial of conditions and how to be self aware of this.
 Acknowledge the probability of some degree of non-compliance, assess their feelings on it
with frank discussion, and discuss minimisation of it.
 Acknowledge that side effects can occur and may be unpleasant with out dismissing the
possibility. Encourage reporting of side effects; ask patients specifically about possible side
effects they may not want to talk about eg sexual problems.
 Allow adequate time for thorough discussion and questions, especially with patients who
are/have elderly, children, adolescent, disability, low socioeconomic status, have a first
language other than English.
 Simplify treatment and drug regimes. Providing clear written instructions for treatment and
side effects and review those with the patient on follow up visits.
 Improve the convenience of liaisons with health professionals, eg make appointment
reminder calls, and follow up on missed appointments.
 And above all: Give the patient shared responsibility for their treatment, monitoring,
directions, and outcome.