Patient adherence

In some pharmacotherapy studies, psychotherapy exposure has been minimized, on the basis of concern that psychotherapy may produce a ceiling effect on improvement in drug or alcohol use, making medication effects difficult to detect. However, a recent meta-analysis revealed that psychosocial interventions, in fact, may enhance pharmacotherapeutic effects (Hopkins et al. 2002). In this review we have also noted instances where psychosocial and medication treatments have had beneficial additive effects. Minimization of psychotherapy in pharmacotherapy trials may be counterproductive, because psychosocial therapies that encourage the patient to remain engaged in treatment may positively affect patients adherence to the medication regimen, a factor that has an effect on alcohol treatment outcomes (Chick et al. 2000 Volpicelli et al. 1997). 

The frequent dosing of isosorbide dinitrate (e.g. 3-4 times daily) is not conducive to patient adherence therefore, a once-daily isosorbide mononitrate is commonly substituted for isosorbide dinitrate to simplify the dosing regimen. A nitrate-free interval is still required when using nitrates for HE... 

Salmeterol is also available in a fixed ratio combination product containing fluticasone, and a new drug application has been filed for a fixed combination product containing budesonide and formoterol. Combination products have the potential advantage of increasing patient adherence due to the decreased number of inhalers and inhalations however, these products offer less flexibility with respect to dosage adjustments when necessary. 

Since POAG is a chronic, often asymptomatic condition, the decision of when and how to treat patients is difficult since the treatment modalities are often expensive and have potential adverse effects or complications. The clinician should evaluate the potential effectiveness, toxicity, and the likelihood of patient adherence for each therapeutic modality. The ideal therapeutic regimen should have maximal effectiveness and patient tolerance to achieve the desired therapeutic response. The American Academy of Ophthalmology (AAO) publishes Preferred Practice Patterns for POAG and POAG Suspect.2... 

Compliance is essential to ensure efficacy of a particular agent. Patients may stop taking their antibiotics once the symptoms subside and save them for a future infection. If the patient does not complete the course of therapy, the infection may not be eradicated, and resistance may emerge. Self-medication of saved antibiotics may be inappropriate and harmful and may select for resistant organisms. Poor patient adherence maybe due to adverse effects, tolerability, cost, and lack of patient education. 

Hypertension for 5 years it is often not well controlled because of poor patient adherence... 

Directly observed therapy A treatment method in which patients are under direct observation when they take their medication or receive their treatment. This method is designed to reduce the risk of treatment interruption and to ensure patient adherence. 

Evaluation of dietary therapy with diet diaries and recall survey instruments allows information about diet to be collected in a systematic fashion and may improve patient adherence to dietary recommendations. 

Patient adherence with the therapeutic regimen should be assessed regularly. Patients should be questioned periodically about changes in their general health perception, energy level, physical functioning, and overall satisfaction with treatment. 

Patient adherence to therapeutic regimens, side effects, potential drug interactions, and subjective measures of quality of life must also be evaluated. 

During the initial evaluation, providing for the safety of the patient is of paramount importance. The severity of intoxication and potential for withdrawal must be quickly and accurately determined. Extreme alcohol intoxication can be fatal either by the production of cardiac arrhythmias, aspiration (the inhalation of stomach contents that are vomited), or other causes. We have all seen reports of college students dying from alcohol poisoning. Likewise, up to 10% of patients in severe alcohol withdrawal can die without treatment. Fortunately, most patients do not experience the most severe forms of alcohol withdrawal such as the DTs. Mild withdrawal can be managed in the outpatient setting with appropriate support and patient adherence, but severe withdrawal requires an inpatient hospitalization. See Section 6.5 for further discussion of the initial evaluation. 

The issues raised by Wosinska (2004) regarding prominence of side-effects warnings in television DTCA and their impact on patient adherence to guideline treatment are complex and undoubtedly of concern not only to advertisers and regulators, but also to patients and their physicians. Her findings are best viewed as preliminary, but clearly worthy of additional research. 

Failures of patient adherence (due to misunderstanding of or failure to read instructions, misperceptions about drugs, bad taste or even appearance of drug formulation, competing advice e.g., from friends, suicide attempts) as well as some bizarre problems such as suicide pacts and homicide attempts. 

Because the effect of patient adherence on the outcome is much more critical, directly observed therapy (DOT) is strongly recommended for persons with HIV-1 infection to ensure that the patient takes every single prescribed dose. This protects against... 

Table 8. General guidelines to improve patient adherence to antihypertensive therapy (Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure, 1997)...

Methimazole is the thioamide of choice based on improved patient adherence and outcomes... 

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