Introduction When a patient is given a regimen by a doctor, or otherwise is advised as to how to get healthy with certain specific steps to take (including medications), but does not heed the advice of the physician, that is a clear-cut case of non adherence. Another word used by Dutton is "compliance," and clearly there are problems for a patient that does not comply with what his or her physician has prescribed. This paper delves into the issue of non adherence, what factors cause a patient to decide not to adhere to a prescribe course of action, the implications of that kind of resistance, and strategies to improve treatment adherence.
Treatment Non-Adherence
When a patient is given a regimen by a doctor, or otherwise is advised as to how to get healthy with certain specific steps to take (including medications), but does not heed the advice of the physician, that is a clear-cut case of non-adherence. Another word used by Dutton is "compliance," and clearly there are problems for a patient that does not comply with what his or her physician has prescribed. This paper delves into the issue of non-adherence, what factors cause a patient to decide not to adhere to a prescribe course of action, the implications of that kind of resistance, and strategies to improve treatment adherence.
Understanding lay perceptions of treatment non-adherence
Adherence to instructions includes doing what is prescribed for your own good. In the case of medicine, if an individual is given a prescription by a physician -- based on the need to remedy an illness or condition -- and that individual balks at taking the medication at the prescribed "frequencies or intervals," or otherwise fails to meet the specifications of the medication (written on the side of the plastic container), he or she is in a situation that can be described as non-compliance, or non-adherence (Dutton).
It may shock some people to know that according to Ley (1997), nearly 60% of people given prescriptions actually follow the instructions and take the medication when it is supposed to be taken. In order to assure that they are taking their medications as instructed, up to 10% of non-adherence patients need to go back to the doctor to get further / additional instructions, which should not have been necessary. Up to twenty percent of patients that do not adhere to a physician's instructions will need additional prescriptions and perhaps ten percent of those same individuals will have to be off work for a couple days because they were delinquent or negligent vis-a-vis their medications. Those non-adhering people put an additional burden on resources and health centers, and in addition, the same people sometimes overdose, fail to realize that mixing prescription medications with home remedies is a losing strategy.
Factors influencing treatment non-adherence
There are reasons why people fail to follow their doctor's advice, and one reason can be related to age; older people are forgetful and they tend to hang on to beliefs even though their ideas may be faulty and out of date. Apparently a majority of American citizens have negative views about prescription medication and that is because they don't see the cost-benefit (Horne) and they have unprofessional approaches to the value of prescription medicine. The ignorance that is out there regarding the use of medications is startling; for example, pills "…rob you of your true self," a patient may say with reference to antidepressants. Yes there are psychological issues to deal with when a person is on antidepressants, but doctors don't dole these medications out like candy. There are valid psychological and physical reasons for a doctor to prescribe powerful medications; not taking them is wasteful and indicates a lack of trust.
The implications of non-adherence to treatment programs
Excuses are a dime a dozen, and patients that rebel against what the doctor prescribed have a plethora of excuses to offer. A patient may see the cost of the medication is too high (perhaps the patient doesn't have Medicare); he may not adhere because he is drinking alcohol heavily every day and is afraid to mix the bourbon with the antidepressant; he may simply be confused because the treatment plan is too complex for his simple mind.
As to the reasons for non-adherence: a) the language used in the doctor's plan may not be understood; b) the list of possible side effects could scare the patient away from adherence; c) the fine print may be esoteric and scary; and d) the jargon used discourages the patient.
Strategies for improving treatment adherence
When family members are brought in by the nurse or doctor to help offer support to the patient, he or she is not going it alone anymore, and that is positive. Family involvement and support is extremely important in terms of improving adherence. Also, encouraging the patient to open up and express feelings and concerns is vital in making the patient believe that this is a sincere program and we really care about you. Keeping a diary is a good idea; the patient can document each day's experience (I didn't take my pills today because I was away from home and forgot them…) and reflect on what the doctor expects and why that is important. In order to reach the patient that may not be well educated, the nurse or doctor must use language that is familiar to the patient; a verbal repetition of the rules of this treatment might be necessary. Following that repetition, the nurse should ask the patient to repeat what he or she understood about what is being prescribed; if he or she can't explain it, then starting over is in order.
The role of the nurse in treatment
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