COMPLIANCE

The wise use of medications requires compliance, understanding, communication, and resources available to assure acquisition of medications and proper counseling. In order to gain the full therapeutic benefit of any medication, compliance with directions is essential.

1. What Does Compliance Mean?
   
   Compliance simply means that you follow the recommendations made by your team of healthcare professionals. These recommendations often include taking medications as well as making lifestyle changes such as stop smoking, eating right and getting the right kind of physical activity in your daily life.
   
   Unfortunately, many people don't recognize the importance of following their doctor's advice in maintaining their health. In fact, many death, increased hospitalizations and delayed recovery from illnesses all occur each year because patients did not follow their doctor's advice properly.

2. What Constitutes Unwise Or Noncompliant Use of Medications?
   
   There are a variety of aspects to unwise or noncompliant use of medications. The most obvious is the omission of doses of medication. This may be the result of forgetting to take a scheduled dose, simply avoiding taking it, or even deciding not to purchase a prescribed medication. The last usually involves an active decision not to take the medication because of possible side effects, misunderstanding the proper needs for the medication, or lack of agreement between patient and prescriber as to the needs or benefits of taking particular medication. For some circumstances, noncompliance may seem appropriate, for example, when adverse effects are being experienced; whereby in most cases, omitting doses of prescribed medication can be considered unwise.
   
   Other forms of unwise use of medications include:

1. Intentionally increasing or decreasing recommended dose of medication.

2. Taking medication for an unintended purpose.

3. Making errors in frequency of administration.

4. Administering the medication incorrectly.

5. Using combinations of prescription and nonprescription (over the counter) medications without proper advice.

6. Taking old medications left over from previous illnesses or sharing someone else's medications for what is perceived to be the proper reason for use in an undiagnosed disease process.

7. Continued use of medications prescribed long time in the past, irrespective of current prescribed therapy.

All these examples of unwise use of medications may have undesired and potentially dangerous consequences.

3. Potential Consequences of Medication Misuse
   
   Failing to use medications wisely may cause both obvious and not obvious adverse consequences. Among them are:

1. Treatment Failure or Relapse of Disease.
   
   Infections, for example, may fail to be resolved and may relapse if antibiotic therapy is prematurely discontinued once the symptoms of the infection abate.

2. Unnecessary Adding or Switching of Medication
   
   The consequences may be more subtle or overlooked. For example, patients’ physicians, or other healthcare providers, observe treatment failure and do not consider non-compliance as a cause may add additional drugs to the patient's therapeutic regimen or may switch to another medication, possibly more expensive or having a higher risk of side effects. These are consequences of unwise use of medication, which are seen quite often in the treatment of chronic diseases such as hypertension, seizures, congestive heart failure, or depression--to name but a few.

3. Toxicity
   
   Incidences where noncompliance or unwise use of medications may result in toxicity are:

1. Situations in which patients decide on their own to increase the prescribed dose or add medications to the current regimen that may precipitate toxic side effects to their drug therapy.

2. Can also occur when a missed or stopped medication causes toxicity of another medication. An example of this type of consequences of medication non-compliance in patient being treated for congestive heart failure with a diuretic, cardiac drug called digoxin, and a potassium supplement. Should the patient fail to take the potassium supplement, which is intended to replace the potassium depleted from the body by the effect of the diuretic, he or she may become hypokalemic (deficient in potassium) and may subsequently develop toxic effects from digoxin.

4. Increased Morbidity/Mortality and Healthcare Cost
   
   Medication misuse may also result in serious and costly medical care, including unnecessary physician visits, hospitalizations, institutionalization, and increased laboratory costs as well as misdiagnosis of disease and subsequently increased drug costs. For example, drug-induced confusion resulting either from prescribed drugs or the use of over-the-counter medications may result in the incorrect diagnosis of "dementia," with subsequent institutionalization and inappropriate therapy for behavior due to the drug-induced confusion. These examples demonstrate that the unwise use of medications can result in increased morbidity and mortality, and consequently increased healthcare costs.
   
   
   

4. Ways to Increase Compliance

1. Working with Physician
   
   Patients often tend to be passive during their communication with healthcare providers, especially the elderly. Many elderly were taught, and believe, that physician is responsible for their health. This might be true previously but it is not the case of today. Today, the elderly, and all consumers, need to develop conversation with their physician and become active decision-makers in the development of their healthcare plans.

2. Provide other information whenever necessary
   
   Once the medical-care provider knows about consumer's health problems and concerns, other information that the consumer should also provide are as follows;

1. Currently prescribed medications from all sources within the last six months.

2. Previously used medication for past medical problems or for current diseases or which a different medication is being used.

3. Both positive and negative reaults of past and present medications. For example has noncompliance been a problem in the past? Why?.

4. All allergies or intolerances to medications, including nature of the reaction and whether therapy is needed to treat the reaction. For example, when hives developed, in addition to stopping the medication, it is necessary to administer antihistamines due to the severity of allergic reaction.

5. All nonprescriptive medications used routinely or occasionally (a good rule is any medication used in the last six months to a year), including a description of the conditions for which these agents were used.
   
   
   

5. Practical Tips
   
   Consumers should consider some helpful hints to ensure wise use of medications. The following tips, addressed to the patient, can enhance communication and prevent misuse of drugs;

1. Keep a list of the names and dosages of all medications used.

2. Review this list with your medical care provider and pharmacist each time you receive a new prescription or purchase a nonprescriptive medication. Ask if the new prescriptive or nonprescriptive medication will present any potential problems to your present therapy.

3. Plan ahead for refill so that you do not find yourself out of medication at a time it is inconvenient or drugs are inaccessible. This is particularly important if you are planning a trip.

4. If you are traveling by car, make sure that medications are not left in the car under the sun or unprotected from high temperatures of a locked car under the sun. If traveling by air, always hand-carry your medications.

5. Have emergency numbers readily available for contacting medical provider, pharmacy, poison control office, and hospitals in case of emergency.

6. Discard all outdated medications or those not used or outdated. If you have any queries regarding old medications, place all old medications in a bag and take them to your pharmacist, who can help you to sort out which on to be discarded.

7. Avoid hoarding and sharing old medications. Likewise, do not refill old medications prescribed by physicians who no longer provide care for you--unless you have discussed this with your present medical care provider.

8. If vials with "child-proof" safety closure caps are difficult to open, discuss with pharmacist the use of easier-opening lids, but bare in mind of potential danger of accidental poisoning if children gain access to the medication. If inhalers are difficult to use, an attachment device called a "spacer" may help.

9. If reading of the label on your medication is difficult or difficulty is experienced when using a syringe to "draw up" your insulin, purchase a magnifying lens or other devices to aid in reading and measuring insulin or other liquid medications.

10. Use of Medication Chart to keep track of your prescribed medications can be challenging - especially if you are taking several types of drugs. The chart enclosed will help you with this task. On the chart, you'll find space to list the different medicines you take, what they are taken and when to take them. You can also make a check mark each time you take the medication. You may find that keeping this chart for only a week or two helps you develop better habits for taking your medications, or you may want to continue using this helpful tool. When you go to your next doctor's appointment, take the chart with you. Your doctor will be able to tell if you are taking the right medications for your treatment and can also alter your dosage, frequency or drugs to suit your individual situation.
    
    
    

6. Managing Medications at Home

1. All medications should be stored in a cool, dry area at home. Therefore, bathroom and kitchen are not an ideal place to keep medication because these areas are humid and for higher temperatures than the other area of the house. Bedrooms may be an ideal place.

2. Patient should always enquire which medication must be refrigerated and which must be kept in the airtight container. For example, sublingual nitroglycerine tablets must be kept in airtight container. Never freeze medication--freezing may cause physical changes that destroy the medication.

3. Administration of medication should be planned around meals, daytime activities, and sleep (Weintraub, 1984). This is where pharmacists and physicians can help patient to plan. Often, drug regimens with multiple medications can be reduced to just a few times of administration daily, making better compliance easier and a more convenient drug therapy.

4. A variety of devices such as calendars, vials with alarm caps, and medication organizers are readily available to enhance compliance. For the visually impaired, color-coded vials and calendars devices, vials with alarm caps, and medication organizers may be used enhance compliance. Also, magnifying glasses may be needed.

5. If necessary, particularly for those who are visually or physically impaired, someone may need to assist patient in administering or organizing medications. Spouses, neighbours, family, or visiting nurses may be required. This may also require contacting social services to help arrange or finance assistance.
   
   
   

7. Conclusion
   
   In order to achieve maximum benefit from healthcare professionals, patients must redefine their relationship with healthcare personnel and their responsibilities as consumers. They must arm themselves with information needed to become an active participant in their welfare and to maintain compliance to their drug therapy.