Monday, July 24, 2017

Here’s why adherence to treatment is important

 

By Dr Frederick Haraka fharaka@ihi.or.tz

Each one of us has had a moment in our lives where we received a prescription be it for short or long treatment.

Treatment can be prescribed with specific instruction of the duration of treatment, meaning, the start and stop date, frequency of drug intake and dosage.

Sometimes treatment is long live where an individual is required to take medication on a daily basis. Chronic disease such as hypertension, HIV to mention a few require live long daily drug intake.

Why adhere to a treatment?

In simple terms, adherence is how much an individual follow and act according to the prescription in terms of frequency of intake, dosage and duration.

Failure to follow such instruction can be referred to as non-adherence. This can be a failure to initiate treatment, failure to implement or discontinue before the end of treatment duration. All these constitute non-adherence.

There are a number of reasons why people don’t adhere to treatment. People with chronic illness who are required to have drug intake daily are more likely to not adhere compared to those who take treatment for two weeks.

Studies have shown nearly 50 per cent of those with chronic illness don’t fully adhere to treatment.

Perceived severity of the disease which the patient has, will determine as to whether an individual will adhere to treatment. The main problem is knowledge about the disease.

People who fully understand the consequences of not taking medication are more likely to adhere compared to those who don’t have full understanding of the disease.

Ways to adhere to medication

It’s the duty of both the attending doctor and the patient to discuss and establish an adherence plan before treatment is initiated.

Understanding the dynamics surrounding a patients’ life, will help in finding ways to better fit in the plan into his or her life.

Improvement in the illness, diminished pain, lack of pain, and ability to resume to normal life are some of the factors linked to inadequate understanding of the disease.

Let us take an example of hypertension, the disease may not present with any symptoms or a patient may present with complications or some symptoms like headache. Some patients have stopped taking medication after their symptoms improved or stopped.

Financial barriers have been shown to impact adherence negatively. Some people don’t adhere simply because they cannot afford the cost for medication.

With chronic illness, costs for medication become a regular budget in the family, thus compete with other needs. It is important that drugs are affordable or subsidised for ordinary people.

Doctor-patient relationship must be at the core to improve and maintain good adherence.

Studies have shown a good doctor-patient relationship where a patient feels confident to discuss and disclose challenges in the course of treatment, have been shown to generally improve adherence.

Good counselling which is tailored to specific patient circumstances cannot be overemphasised.

Reminder text message to patient have shown to improve adherence. These are automated text messages which patients who are taking drug on a daily basis receive through their mobile devices such as phones.

Other strategies include dispensing drugs in small quantities, example weekly to allow monitoring especially during the initiation period.

Use of treatment supporters within the family, treatment support groups and community healthcare workers depending on local circumstances are proven strategies to improve adherence.

There are quite a number of drugs for different diseases which are being developed.

These drugs are developed to become more potent with less side effects as well as easy and friendly modes of administration.

However efficacious these drugs are, their effectiveness will depend greatly on adherence to specific prescription instructions. Good adherence does not only have good clinical outcome but also cost implications.

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