* This is the Consumer Version. *
Adherence to Drug Treatment
(See also Overview of Response to Drugs.)
Adherence is the degree to which a person takes prescribed drugs as directed.
Adherence to (compliance with) drug treatment is
* This is the Consumer Version. *
Adherence to Drug Treatment
(See also Overview of Response to Drugs.)
Adherence is the degree to which a person takes prescribed drugs as directed.
Adherence to (compliance with) drug treatment is important. However, only about half the people who leave a doctor's office with a prescription take the drug as directed. Among the many reasons people give for not adhering to drug treatment, forgetfulness is the most common. The key question then is: Why do people forget? Sometimes, the psychologic mechanism of denial is at work. Having a disorder causes concern, and having to take a drug is a constant reminder of the disorder. Or, something about the treatment, such as possible side effects, may greatly concern the person, resulting in a reluctance to follow the plan.
Most obviously, if a person does not adhere to treatment, symptoms may not be relieved or the disorder may not be cured. However, not adhering may have other serious or costly consequences. Not adhering is estimated to result in 125,000 deaths due to cardiovascular disease (such as heart attack and stroke) each year. In addition, it is thought that up to 23% of nursing home admissions, 10% of hospital admissions, and many doctor visits, diagnostic tests, and unnecessary treatments could be avoided if people took their drugs as directed.
Not only does not adhering add to the cost of medical care, it can also worsen the quality of life. For example, missed doses can lead to optic nerve damage and blindness in people with glaucoma, to an erratic heart rhythm and cardiac arrest in people with heart disease, and to stroke in people with high blood pressure. Not taking all prescribed doses of an antibiotic can cause an infection to flare up again and may be contributing to the problem of drug-resistant bacteria.
Children are less likely than adults to take drugs as directed. In a study of children who had streptococcal infections and for whom a 10-day course of penicillin was prescribed, 56% were not taking the drug by the third day, 71% were not taking the drug by the sixth day, and 82% were not taking the drug by the ninth day. For children with chronic diseases such as type 1 diabetes or asthma, adherence is difficult to achieve because their treatment plan is complex and must be continued for a long time. Getting children to take drugs that do not taste good, seem frightening (such as eye drops or those that require a mask over the face), or require injections can also be difficult.
Sometimes parents do not understand a doctor's instructions. Also, parents (and patients) forget, on average, about half the information 15 minutes after meeting with a doctor. They remember the first third of the discussion best and remember more about diagnosis than about the details of treatment. That is why doctors try to keep the treatment plan simple and often provide written instructions.
Although adherence is probably not affected by old age itself, it is affected by several factors that are common among older people, such as physical or mental impairments, the use of more drugs, and an increased risk of drug-drug interactions and side effects. Taking several drugs makes remembering when to take each drug harder and increases the risk of adverse drug-drug interactions, particularly when over-the-counter drugs are also being taken. Doctors may be able to simplify the drug regimen—by using one drug that serves two purposes or by reducing the number of times a drug must be taken—to improve adherence and to reduce the risk of interactions.
Because older people are generally more sensitive to drugs than younger people, they are more likely to have adverse drug reactions and may require a lower dose of certain drugs (see Aging and Drugs).
People are more likely to adhere to treatment if they have a good relationship with their doctor and pharmacist. Such relationships involve two-way communication.
Communication can start with an information exchange. By asking questions, people can come to terms with the severity of their disorder, intelligently weigh the advantages and disadvantages of a treatment plan, and ensure that they understand their situation correctly. By discussing concerns, people can learn that denial of their disorder and misconceptions about their treatment can lead to forgetting to take drugs as directed, resulting in unwanted effects. Doctors and pharmacists can encourage adherence by providing clear explanations about how to take the drugs, why the drugs are necessary, and what to expect during treatment. When people know what to expect from a drug, good and bad, they and the health care practitioners involved in their care can better judge how well the drug is working and whether potentially serious problems are developing. Written instructions help people avoid mistakes caused by poor recall of their discussions with the doctor and pharmacist.
Good communication is important, particularly when people have more than one health care practitioner, because it ensures that all practitioners know all the drugs prescribed by the others, and an integrated treatment plan can be developed. Such a plan can help reduce the number of side effects and drug-drug interactions and possibly result in a simpler drug regimen.
Participating in decisions about their treatment plan makes people mo