Doing what the doctor orders

Wednesday, 5 February, 2014
One of the ‘chronic’ conditions in the healthcare field is patient non-compliance with the dosage prescribed on the bottle. Yet this is something that has only started to receive attention from experts in the last 40 years.

Now, a European multidisciplinary team of more than 30 professionals, led by Professor Przemyslaw Kardas of the Medical University of Lodz, Poland has completed the first systematic assessment of the problems of posology, as it is known. The team  includes doctors, nurses, pharmacologists, sociologists, anthropologists, statisticians and medication management specialists.

Operating under the banner of the ABC project (Ascertaining Barriers for Compliance: policies for safe, effective and cost-effective use of medicines in Europe) the team came up with a structured and in-depth original approach.
The challenge was big, as the World Health Organisation (WHO) had already identified partial or total non-compliance as a characteristic of nearly half the world’s population.

To meet the challenge, the ABC team looked at all meaningful aspects of the problem, from patient behaviour to the legislative environment to current healthcare practice in the EU Member States. The team established a taxonomy for analysing the issue, based on the behavioural and pharmacological sciences, and came up with expert-approved standard definitions to guide them.

The fieldwork that followed included international surveys into patient attitudes and behaviours, multi-country studies of compliance management by healthcare professionals and institutions, and an analysis of the effectiveness and costs of compliance-enhancing procedures.

The ABC project team’s findings strongly suggest that the development of customised IT software plus feedback to patients is the most effective solution. In the words of Professor Kardas, “as every patient is at some risk of non-adherence, everyone should be supported, instead of being blamed for non-adherence and failing to attain the goals of the treatment.”

Ultimately, this age-old problem of patient non-compliance comes back to issues of human inertia and mistrust of pharmaceuticals, with a strong element of wishful thinking. Also because someone’s complaint is a chronic one that needs time to respond, such as a high cholesterol level, the patient may think the medication is ineffective.

Professor Kardas points out that the whole non-compliance issue is personal and subjective, as illustrated by just one statistic emerging from the ABC project. “While only 20% of Dutch respondents with high blood pressure admit ignoring ‘doctor’s orders’, two-thirds of Hungarian respondents confess to non-compliance,” adds Professor Kardas.

The ABC project represents a major step forward in fighting patient non-compliance and provides a multidimensional benchmark for tracking progress in the future.  

certaining barriers for compliance: policies for safe, effective and cost-effective use of medicines in Europe
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