Compliance may be defined as the extent to which the patient follows a prescribed regimen. The assumption that the patient follows directions on the prescription is unrealistic. The patient is the final and most important determinant of how successful a therapeutic regimen will be and should be engaged as an active participant with a vested interest in its success. The prescriber must promote a collaborative interaction with the patient in which each helps to determine the course of therapy. The patient's quality-of-life beliefs may differ from the clinician's therapeutic goals, and the patient will have the last word when there is an unresolved conflict. Suggestions for improving patient compliance are listed in Table A-2.

Even the most carefully prepared prescription for the ideal therapy will be useless if the patient's level of compliance is inadequate. Noncompliance, thought to occur 50% of the time, may be manifest in drug therapy as intentional or accidental errors in dosage or schedule, overuse, underuse, early termination of therapy, or not having a prescription filled. Noncompliance always should be considered in evaluating therapeutic failures.

1148 Appendix A Table A-2

Suggestions for Improving Patient Compliance

Provide respectful communication; ask patient how he takes medicine.

Develop satisfactory, collaborative relationship between doctor and patient; encourage pharmacist involvement.

Provide and encourage use of medication counseling.

Give precise, clear instructions, with most important information given first.

Support oral instructions with easy-to-read written information.

Simplify whenever possible.

Use mechanical compliance aids as needed (sectioned pill boxes or trays, compliance packaging, color-coding).

Use optimal dosage form and schedule for the individual patient.

Assess patient's literacy and comprehension and modify educational counseling as needed. Don't rely on patient knowledge about his or her disease, alone, to improve compliance.

Find solutions when physical or sensory disabilities are present (use nonsafety caps on bottles, use large type on labels and written material, place tape marks on syringes).

Enlist support and assistance from family or caregivers.

Use behavioral techniques such as goal setting, self-monitoring, cognitive restructuring, skills training, contracts, and positive reinforcement.

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