For a drug to work, it must be taken properly and regularly. Not infrequently, patients deviate from the doctor's prescribed regimen; Consequence: The effect of the remedy can be questioned and thus the entire healing process.
Compliance and non-compliance
In science, one calls the necessary adherence to therapy and the consequent adherence to the medical revenue regulations "compliance", the opposite of it "Non-Compliance". If a drug does not work, then it is often the behavior of the patient.
You read, for example, the leaflet, is disturbed by the long list of possible side effects and then occasionally turn off the tablet intake in the belief that they even do something good. Although other patients start with the therapy, but stop the drug as soon as the symptoms improve or unwanted side effects occur.
Also, the subjective feeling "I feel fine today" as well as forgetfulness contribute to poor adherence to therapy. This is especially true if several medications need to be taken daily or the treatment takes a long time.
Non-compliance widely used
Studies repeatedly show that it is not well ordered with the compliance of many patients. Depending on the clinical picture, the extent of this non-compliance is estimated to be between 12 and 35 percent.
Especially patients with respiratory diseases, diabetes mellitus and sleep disorders often do not stick to their medication. When prescribed long-term use of drugs, the numbers are even more frightening: Only about 40 to 50 percent of patients with chronic diseases such as hypertension or asthma follow the doctor's advice to take medication.
The consequences of poor adherence are often underestimated; they usually weigh much heavier than the burden of any side effects.
Causes of non-compliance
There are many reasons why patients do not follow the medication: social, economic, disease, therapy or personal factors can play a role. For example, the so-called "dental plaster effect" is known, wherein the patient takes the medicine irregularly but keeps himself correctly to the prescription a few days before a doctor's visit. Or one speaks of so-called "medic vacation", if the consumption is suspended for a certain time mainly on weekends or on vacation.
Measurement of adherence
In order to investigate the extent and causes of a lack of adherence, it is important to measure compliance. One differentiates between direct and indirect measuring methods:
- Direct method is the measurement of drug concentrations in the blood,
- indirect methods include patient diaries, tablet counting (how many are left, how many have been taken in a given period of time), and doctor discussions with the patient about ingestion behavior.
Impact of non-compliance
For example, studies on patients who have had an organ transplanted and who are given permanent medications to suppress their own immune system, so that they do not reject the new organ, show just how fatal a lack of adherence can be. On average, every fourth patient does not follow the rules for taking these so-called immunosuppressants. Consequence: The immune system fights against the new organ until it finally fails.
Similarly, in patients infected with the HI virus, similarly devastating consequences of poor adherence were observed. In addition to the health consequences, there is also an economic aspect: Who does not take his medication properly, risking more frequent visits to the doctor, longer treatment periods and hospitalization, which means a loss of work and thus loss of productivity and on the other a burden on the general health system.
Thus, the direct and indirect costs of non-compliance in Germany are estimated at 7.5 to 10 billion euros annually. For comparison: In 2006, the health costs borne by statutory health insurance amounted to approximately € 137 billion, demonstrating the considerable magnitude of the costs of treatment failure.
Education and care important
However, it is not always the patient alone who is responsible for the lack of adherence to therapy. Often a lack of trust between doctor and patient also plays a role: The doctor explains too little, and many patients know too little about their illness and their treatment and are not aware of the importance of regular medication.
Patient education could significantly improve compliance. Sometimes even family or friends do not make it easy for the patient if, for example, the disease is simply declared a taboo subject.
By contrast, an open approach to suffering as well as support and motivation by relatives help the patient to accept his illness and treatment. An important role in the question of whether a patient demonstrates a high adherence to therapy, in addition to the doctor and the pharmacist. Recent scientific studies prove that the interaction of patient, doctor and pharmaceutical care by the pharmacist provides the basis for effective adherence to therapy.
Remuneration is also an issue for drug researchers: in the meantime, they have developed combined preparations for many diseases that require several drugs for their treatment: instead of two or three different tablets, only one that contains all active ingredients. Even drug forms that release a drug continuously over hours or days, so-called sustained release forms, contribute to adherence. Because, for example, the intake is enough once a day, for example at breakfast.