Transcript HEALTH AND FAMILY DYNAMICS

ADHERENCE
(COMPLIANCE)
Kai-Lit Phua, PhD FLMI
Associate Professor
School of Medicine & Health
Sciences
Monash University Malaysia
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.
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
NONADHERENCE
Nonadherence is widespread (some
estimates go as high as 50%!)
The consequences can be serious e.g.
diabetes mellitus, hypertension
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
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
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!
THE END
THANK YOU