Medical non-compliance
...to the successful delivery of healthcare. (2) Non-compliance has potentially major clinical and economic consequences. Terminology, Definition and Forms of non-compliance. According to John Steiner & Mark Earnest (2000) (3) various terms had been used to describe a patient who did not follow the doctor’s advice. In the early 1900s, tuberculosis patients who failed to follow medical instructions were called “defaulters.” Over the next 50 years, patients were described as “faithless,” “untrustworthy,” or “unreliable” when they failed to follow doctors’ orders. In the mid-1970s the term “compliance” was officially recognised and “non-compliance” was used to describe those who “dropout” of treatment. “Compliance” is generally used to mean, “the extent to which a person’s behavior (in terms of taking medications, following diets, or executing lifestyle changes) coincides with medical or health advice,” according to Brian Haynes, MD, and colleagues in the 1979 book Compliance in Health Care. The forms of non-compliance The five most common forms of non-compliance identified are (2): a) not having the prescription given, b) taking the incorrect dose, c) taking the medication at the wrong time, d) forgetting to take one or more doses, e) stopping the medication to soon. Studies done in US showed that only 1/3 of patients take all their medicine, 1/3 take some, 1/3 don't take any at all of the medication prescribed. (4,5) It also found that about 50% of the 2 billion prescriptions given each year are not taken correctly (6). The extent of non-compliance According to P. Jaret (2001) (1), studies done in US over the past three decades have shown that non-compliance can range from 20% to a staggering 80%, depending on the kind of treatment. On average, patients follow doctors’ advice exactly about half of the time. And when a treatment regimen is complicated or difficult to follow such as involving lifestyle changes to control hypertension or diabetes, the compliance is even lower. As a result only about one in four people with hypertension manages to control his or her blood pressure adequately. In an article published in the Journal of the American Medical Association in May 1998, Harvard Medical School researchers reported that only 52% of patients prescribed lipid-lowering medications were still taking their prescriptions after five years. The studies on non-compliance in Malaysia are scare. In the National Health and Mobidity Survey done in 1996 (7), 21,391 adults 30 years and above were examined for the present of hypertension. It was found that only 23% of them were on treatment and an only 6% of them had their hypertension well controlled. Could non-compliance be one of the causes for such a low rate of good hypertensive control? The social, economic and financial impact of non-compliance The costs for non-compliance are high (8). According to Charles V. Pumilia (2002)(9) patient compliance affects all corridors of medical practice and is responsible for an innumerable loss of human life, and financial resources each year. Therefore, it is not only the patients that suffer from the consequences of non-compliance but also the governments and the pharmaceutical industries. From the patient’s perspective, he or she can only enjoys the full benefits of today’s potent life-saving drugs only if they are taken precisely as directed. Therefore, non-compliance can be life-threatening depending on how serious the medical condition is. Non-compliance can jeopardize not only themselves but also those around them if people with drug-resistant tuberculosis do not take their medications regularly or those with infections do not complete their course of antibiotics leading to the emergence of resistant strains. For more chronic illnesses such as hypertension, the patient who decides that the antihypertensive drug is just not worth the trouble to take after a few months would clearly run an increased risk of getting a heart attack or a stroke. (1) This in turn would lead to significant financial burden to him and his family due to the loss of earning capacity. From the government and society point of view, non-compliance has significant negative economic impact. Studies done in the US have shown than non-compliance causes 125,000 deaths annually (10). It is estimated that 23% of nursing home admissions are due to non-compliance (11), which cost $31.3 billion. In addition, 10% of hospital admissions are due to non-compliance (12,13) costing $15.2 billion. Over the last few years, ...