Sunday, January 15, 2006

medication, noncompliance

Over the past decade it has become increasingly evident that a significant percentage of patients fail to follow precisely advice on the use of their medication as well as other prescribed regimens such as diet, exercise, and the use of tobacco and alcohol. Noncompliance rates are estimated to be in the range of 25 percent to 50 percent. The elderly use more medications than the rest of population and are more likely to confuse or forget their medications.
Noncompliance with drug therapy generally consists of four problems:
1. Failure to have a prescription filled
2. Improper administration of the medication
3. Premature discontinuation of the medicine
4. Taking inappropriate medication
Prescriptions are not filled usually for one of two reasons-the patient does not have the money or the patient does not understand or believe in the benefits of the medication. Errors can occur in both overdosing and underdosing. It is a common misconception that if one tablet is good, two will be better.
Sometimes dosages are decreased to conserve on use because of the expense of the medication. Some medicines that should be taken with meals may be missed if the patient does not eat three meals a day as is presumed when prescribing such medicine.
When a patient begins to feel better medication may be discontinued too soon. This is a common occurrence with antibiotics, which need to be used for 10 full days.
The use of inappropriate medication occurs for a variety of reasons. A person may save old prescriptions and use at will at an incorrect time. If the physician is not aware of all the medications that a patient is taking, a noncompatible drug may be prescribed.
Often, older people will share medicines of family members who develop similar illnesses.
To assist in encouraging proper compliance, medication calendars are available to record the names and times for taking each drug. Packaging devices have been developed to enable the patient to take the prescribed dosage. Though such packaging increases the cost of the medication, it may be well worth it since it promotes better compliance.
See also MEDICATION, SELF; POLYPHARMOCOTHERAPY.
Covington, T., and Walker, J. Current Geriatric Therapy. Philadelphia: W. B. Saunders, 1984.

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