NON-COMPLIANCE
By Ms. Seemab Ashraf
Compliance
“The extent to which the patient’s
Behaviour (taking medication, following a diet, and/or
executing lifestyle changes) matches the prescriber’s
recommendations”
Adherence
“The extent to which the patient’s
behaviour matches agreed recommendations from the
prescriber.”
While adherence is a more patient-centered term that acknowledges the partnership
between the patient and healthcare provider in making decisions about treatment,
compliance tends to emphasize the patient's responsibility to follow the prescribed
regimen.
Adherence presumes the patient's agreement with the recommendations, whereas
compliance implies patient passivity.
Non-Compliance
Non-compliance describes the situation when a patient fails to follow the prescribed
treatment regimen or does not adhere to the instructions and recommendations
provided by their healthcare provider.
Non-Compliance with therapy is one of the biggest threats to successful treatment and
one of the most common problems encountered in clinical practice.
Extent of Non-Compliance
Medication compliance can affect quality and length of life, patient safety, health
outcomes, and overall healthcare costs.
Typically, compliance rates of 80% or more are needed for optimal therapeutic efficacy.
According to the WHO, approximately 50% of patients with chronic conditions do not take
medications as prescribed.
Non-compliance can account for up to 50% of treatment failures, around 125,000 deaths,
and up to 25% of hospitalizations each year in the United States.
Approximately $100 to $300 billion in healthcare costs could be curtailed annually by
addressing medication adherence.
Levels of Non-Compliance
Partial non-compliance: It involves partially adhering to the treatment plan. This may
include missing occasional doses, irregularly attending appointments, or occasionally
deviating from recommended lifestyle changes.
Intermittent non-compliance: At this level, the patient may follow the treatment plan for
a certain period and then discontinue or deviate from it for a period of time before
resuming it. This intermittent pattern can be problematic as it disrupts the continuity
of care and can lead to suboptimal treatment outcomes.
Complete non-compliance: When the patient consistently fails to adhere to any aspect
of the prescribed treatment plan. Complete non-compliance can have
severe consequences, leading to poor disease management, increased
risk of complications, and compromised health outcomes.
Methods to Assess Compliance
Direct It involves directly observing or measuring the patient's
behavior. These methods provide real-time or objective
Measure information about the patient's compliance.
Types of Non-Compliance
Failure to have prescription dispensed or refilled or renewed
Omission of
doses
Error of dosage
Incorrect administration
Errors in the time of administration
Premature discontinuation
Causes of Poor or Non-Compliance
Patient Disease
Related Related
Problems Problems
Health
Therapy
Professional
Related
Related
Problems
Problem
1. Patient Related Problems
2. Disease Related Problems
Psychiatric • These diseases make patient uncooperative
diseases towards therapy. E.g. forgetfulness
• Some chronic diseases are not associated
Chronic diseases with symptomology which leads to non-
compliance
Improved disease • It makes the patient ready to discontinue the
conditions therapy
Disease leading to • Diseases that interfere with the patient’s
ability to comply with prescription. E.g.
disability Arthritic patients
3. Therapy Related Problems
Multiple Drug Therapy
Frequency of Administration
Duration of Therapy
Adverse Drug Reactions
Cost of Therapy
Taste and Smell of Medicines
Inappropriate Labelling or Improper packaging
4. Health-Professional Related Problem
Patient-Physician Interaction
Lack of knowledge and training on managing chronic diseases
Quality of Health Care Practice (Overworked HCP, Short Consultations)
Weak capacity of the system to educate patients and provide follow-up
Examples
Medication Usual Barrier Possible Solution
Statins Side effects like muscle pain Educate about benefits of statins and address
concerns of side effects.
Anti-depressants Side effects (weight gain, sexual Patient reassurance, regular follow up
dysfunction), lack of immediate
improvement in symptoms
Anti-hypertensive Asymptomatic nature Patient education, Simplify the medication
Multiple daily doses regimen, Regular monitoring of BP
Insulin Fear of injections, difficulty in Education on insulin administration
managing insulin doses techniques, Use of insulin pens
Diuretics Urinary urgency Allow patient to choose when to dose
Examples
Medication Usual Barrier Possible Solution
Metformin Diarrhea Reassure patient that diarrhea will resolve
within few days, gradual dose titration, take
with or after meals
Antibiotics Feeling better before completing Emphasize on taking full course of antibiotics,
the full course, forgetting to take use reminder systems, clear instructions
doses, side effects about side effects
Asthma Inhalers Difficulty using the inhaler Proper training on inhaler. Address concerns
correctly, concerns about side about side effects and the importance of
effects regular inhaler use.
Antiplatelet drugs Concerns about bleeding risks Educate on the benefits in preventing blood
clots and reducing the risk of complications.
Provide instructions on managing minor
bleeding.
Strategies for Improving Compliance
Patient education, and support instead of blaming
Enhance patient-provider communication
Address concerns and barriers
Collaborative decision-making
Simplify treatment regimens (fixed dose-combinations or SR/XR formulations)
Compliance chart
Patient reminders by using digital tools (medication reminder apps, alarms, pill
organizers, or automated phone calls
Monitor and track the patient
Improved access to health care and medicines
Tools to Improve Compliance
Tools to Improve Compliance
