A 28 year old female patient with schizophrenia effective disorder came to AKU-ER in most unpleasant and unmanageable condition. Patient was not regular with her prescription and follow ups. It looks that she has developed non adherence with medication that is witnessed by relapse of symptoms. According to WHO compliance is ‘the extent to which the patient’s behaviour matches the prescriber’s recommendations’
This scholarly paper will help me to educate my patient for non compliance so she can cope up with her condition. Secondly non compliance is not only common in mentally ill patient but also with other medical illnesses. This article will help us to explore the reasons of non compliance, how common is non compliance, ways to enhance the compliance, what patient families can do for non compliance and also go through on the studies in regard of non compliance.
In my clinical at AKU psychiatric ward, I encounter many patients with non compliance. When I interviewed few of them. They all have different point of view about non compliance. One patient said that she don’t need any medication because she has no illness while other said that these medication have more side effect than required effect and third said that she don’t find any therapeutic effect of medication and they are not useful for her illness. It means that absence of insight, side effect of medication and long time for action of medication are the factors contribute towards non compliance.
According to WHO approximately 50% or more of the patients on long-standing treatment for illnesses, either do not take medications appropriately or totally discontinue taking medication. Non compliance with antipsychotic medicine is seen with 50% of people suffering from schizophrenia. (R Gray., et al 2002).
Non compliance occur because Culture impedes to Treatment and Compliance in a way that
Various health beliefs and behaviours are culture-based; it follows when two dissimilar cultures come collectively in a health care setting, a crash of expectations frequently occurs. Health care professional frequently view their patients culture as a hurdle to care. Eastern people have very different beliefs about disease causation and its treatment from those of western. Eastern patients and their families many times belief on traditional healing and seek the assistance from doctor when condition deteriorate extensively. Many eastern have misperceptions about medical treatments and they are unwilling to talk about their understanding and their preference for cultural healing method with their doctors that can lead to poor treatment outcomes.
According to survey 2001 most Americans are comfortable in questioning their doctors about using alternative medicines and traditional methods whereas, eastern people who are not familiar with Western health care are less liable to discuss such information because they think Western doctors will not recognize their culture-based remedies and people also discontinue medication once symptoms disappear.
Compliance can be enhance through educating patient about illness and importance of maintaining treatment, identify the factors leads to noncompliance(Richard Balon 2002), establishment of a strong association with the patient, educate patient about the medication, drug interactions, pharmacokinetics and there side effects(cited in Richard Balon 2002) and, don’t give complicated drugs regimen.
Families can help their patient by not showing judgemental and threatening behaviour while asking patient about non compliance, most significant family member (like Spouse, parents) should talk to patient and persuade patient on taking medicines by showing its benefits on which patient agrees.
According to cross culture of health care provider and patient is also one of the cause of non compliance because that hinders in the effective communication as well as in the success of treatment. This problem can be minimize if health professional give some extra time to build rapport before dealing with medical issue, health care provider should have culture based family dynamics so they can respond patient accordingly, heath care provider show emphatic behaviour rather than judgemental, encourage patient to question about medication and express that you are aware of traditional remedy used by patient.
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