non-compliance
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Introduction
Failure to comply with prescribed treatment/medications.
Etiology
- low health literacy* is the most common cause of medical non-compliance[1]
- more informed patient tend to have better compliance & better outcomes[2]
- fear, disrespect & denial may be reasons of non-compliance[1]
* low health literacy can interfere with ability of patients to understand treatment plans & result in poor health outcomes & ineffective use of health care resources[1]
Epidemiology
- in general, compliance with long-term treatment is 40-60%
Management
- The most effective approach for exploring medical nonadherence with a patient is to begin with nonjudgmental questions[6]
Notes
- 31% of prescriptions are never filled[5]
- older patients are more compliant with medications than younger patients[5]
- some prescribed medications are unnecessary or even harmful; patients might have good reasons not to fill those prescriptions[5]
- patients who receive free medications are 63% more likely to fill prescription[5]
- change in pill color may be associated with non-compliance[4]
References
- ↑ 1.0 1.1 1.2 1.3 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - ↑ 2.0 2.1 Wu JY, Leung WY, Chang S, Lee B, Zee B, Tong PC, Chan JC. Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trial. BMJ. 2006 Sep 9;333(7567):522. Epub 2006 Aug 17. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16916809
- ↑ Prescriber's Letter 14(8): 2007 Medication Adherence Toolbox General Information About Medication Adherence Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230811&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 4.0 4.1 Kesselheim AS et al. Variations in pill appearance of antiepileptic drugs and the risk of nonadherence. Arch Intern Med 2012 Dec 31 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23277164 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1487287
- ↑ 5.0 5.1 5.2 5.3 5.4 Moloo J Understanding Primary Nonadherence to Prescribed Medications NEJM Journal Watch. May 1, 2014 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
Tamblyn R et al. The incidence and determinants of primary nonadherence with prescribed medication in primary care: A cohort study. Ann Intern Med 2014 Apr 1; 160:441 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24687067 <Internet> http://annals.org/article.aspx?articleid=1852865 - ↑ 6.0 6.1 NEJM knowledge+ Question of the Week. Dec 20, 2022 https://knowledgeplus.nejm.org/question-of-week/820/
Poulter NR et al. Medication adherence in hypertension. J Hypertens 2020 Apr; 38:579 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31834123
Kini V, Ho PM. Interventions to improve medication adherence: a review. JAMA 2018 Dec 18; 320:2461 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30561486