Compliance patient

Compliance to treatment is defined as adherence to treatment by the patient, as prescribed by the physician. Various causes of noncompliance may be identified (1) patient-related causes, e.g., the patient does not understand the processes behind the disease or the aim of the treatment, a problem that might be more specifically encountered with inhaled glucocorticosteroids than with p -agonists, as the immediate effects of inhaled corticosteroids are not perceived (2) inhaler-related causes, e.g., inhalers that are impractical, not portable, or difficult to use (3) financial causes, e.g., insufficient reimbursement of the treatment, an issue that may vary from one country to another. 

Poor compliance has detrimental effects, as the occasional or systematic omission of a dose excludes the patient to benefit from the expected effects. Lack of compliance in patients who need a chronic treatment with inhaled glucocorticosteroids or inhaled long-acting Pj-agonists may result in a less optimal control of the disease and persistent morbidity from asthma (20). It is also a major cause of apparent treatment failure (21) and causes excess in mortality (22). 

It has been shown that compliance may be improved by regular instruction and education (27-29) as well as by a reduction of the number of daily inhalations (30). In this context, it is likely that the combination of a glucocorticos-teroid with a long-acting Pj-agonist in one formulation may improve compliance 

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These drugs exert their effects on airway function by mediation of P -receptors located on the surface of the smooth muscle and other tissues of the airways. Pj-and Pj-receptors are, however, distributed throughout the body. Stimulation of these receptors are considered to be responsible for side effects, such as tachycardia, arrhythmias, prolongation of the Q-Tc interval, tremor, and decrease in serum potassium, and become generally apparent when higher than conventional doses are inhaled (32-34). The relationship between increase in FEV, and the inhaled dose of a Pj-agonist is not linear but consists of a steep part followed by a plateau (34). 

Patient compliance is important for successful drug therapy. Compliance in this context is defined as the extent to which the patient follows the clinical prescription. Non-compliance and reasons why patients do not always take drugs as prescribed should be appreciated. Some common reasons for non-compliance are that the patient has doubts about a drug s effectiveness, they believe they are cured, they misunderstand instructions, dosage regimes are too complicated, or they experience unacceptable side effects. 

Health care professionals play an important role in improving compliance. This is particularly important if a drug is for serious conditions like epilepsy, glaucoma or hypertension, or is for infection because of the problem of drug resistance. 

Well-informed patients are more likely to be compliant. 

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Aerosolized steroids clearly play an important role in the present-day management of asthma (87). They are reasonably safe and work best when taken prophylacticaHy. Patient compliance, however, remains a significant problem. In part this problem is typical of any aerosolized agent. But in the case of steroids, the problem is exacerbated because a patient needs to take the steroids (especially prednisone) are the antiasthmatic agents of last resort and are widely used to treat status asthmaticus. An agent that could mimic the actions of steroids but which would work faster and/or without side effects might be the ideal antiasthmatic agent. 

Second-Generation Antidepressants. The frequency of adverse effects associated with first-generation antidepressants and the lack of patient compliance arising from such adverse effects led to the development of a number of second-generation antidepressants. 

Initial daily doses of 10-40 and 100-600 mg are recommended in clinical practice for MMI and PTU, respectively [1, 2]. Several studies have shown that treatment of hyperthyroidism with single daily doses of 10-40 mg of MMI is effective in the induction of euthyroidism in 80-90% of patients within 6 weeks [2]. The aim of the further antithyroid therapy is to maintain euthyroidism with the lowest necessary diug dose. Intrathyroidal diug accumulation is one cause for the efficiency of a single daily dose regimen. Moreover, a once daily dose yields better patients compliance. Single daily doses of PTU have been shown to be less effective in achieving euthyroidism than administration of three divided doses a day. If a once daily... 

Frequent follow-up sessions are needed to determine compliance with the drug regimen. If a follow-up visit is not feasible, die nurse considers a telephone call or home visit. It is vital tiiat the nurse strive to develop a caring and nurturing relationship with the patient. Compliance is enhanced when a patient trusts the nurse and feels comfortable confiding any problem encountered during drug tiierapy. 

Polyethylene glycol (PEG) consists of repeating units of ethylene glycol forming linear or branched polymers with different molecular masses. Pegylation is the process by which PEG chains are covalently attached to lEN molecules. Pegylation confers a number of properties on lEN-a molecules, such as sustained blood levels that enhance antiviral effectiveness and reduce adverse reactions, as well as a longer half-life and improved patient compliance (Kozlowski et al. 2001). 

Although nodular-cystic forms required eight to ten applications, a significant improvement of the coexisting post-acne superficial scarring was noted. The procedure was well tolerated and patient compliance was excellent [12]. In the treatment of atrophic acne scars (Fig. 2.6),... 

Because of its convenience and good patient compliance, oral administration is the most preferred drug delivery form. As a result, much of the attention of in silico approaches is focused on modeling drug oral absorption, which mainly occurs in the human intestine. In general, drug bioavailability and... 

Compared with monotherapy, combination therapy is relatively unstudied in terms of the effects on CHD event reduction and may reduce patient compliance through increased side effects and increased costs. When used appropriately and with proper precautions, however, they are effective in normalizing lipid abnormalities, particularly in patients who cannot tolerate adequate doses of statin therapy for more severe forms of dyslipidemia. 

Type 2 diabetes mellitus since age 36 it is often not well controlled because of poor patient compliance Hypertension x 3 years, currently controlled History of hepatitis B... 

Approximately one-third of patients with MDD do not respond satisfactorily to their first antidepressant medication.37 In such cases, the clinician must evaluate the adequacy of antidepressant therapy, including dosage, duration, and patient compliance.17 Treatment reappraisal also should include verification of the patient s diagnosis and reconsideration of clinical factors that could be impeding successful therapy, such as concurrent medical conditions (e.g., thyroid disorder), comorbid psychiatric conditions (e.g., alcohol abuse), and psychosocial issues (e.g., marital stress).16... 

Antimicrobial therapy is the cornerstone of treatment in UTIs. This therapy should ideally be well tolerated, narrow in antimicrobial spectrum, lend itself to patient compliance (taken as infrequently as possible), have adequate concentrations at the site of the infection, and have good oral bioavailability. Table 76-2 reviews antibiotics frequently used to treat UTIs with comments on their use, and Table 76-3 reviews frequency, duration, and doses of those antibiotics. 

Monitor patients every 3 to 6 months for a reduction in lesions or disease remission. Monitoring parameters include patient compliance, disease remission, and benign or cancerous tumors. 

Treatment is based on several factors including likelihood of patient compliance, whether it is the first or a recurrent episode, host immunity, and pregnancy. However, patient response has been linked to the time it takes to initiate treatment after symptom onset. 

Advantages Simplified regimen for patient Increased patient compliance at home Decreased labor Decreased costs Decreased risk of contamination (due to less manipulation) Minimize infusion-related reactions from intravenous lipid emulsions Decreased vein irritation (especially with PPN) Improved stability compared to TNA Increased number of compatible medications Decreased bacterial growth compared to TNA Easier visual inspection Can use 0.22-micron bacterial retention filter Cost savings if unused (i.e. not spiked) intravenous lipid emulsion can be reused... 

We have thus far focused on the biological factors that affect drug responses but recovery from illness often takes place in the context of interactions among individuals. In these interactions, both patient and clinician bring their own knowledge, predispositions, values, priorities, modes of thinking, and belief systems into play. Within this transaction, issues such as patient compliance, expectation effect ... 

In the treatment of chronic diseases, a long term zero order release dosage form is highly desirable as it reduces fluctuations of drug levels, reduces toxicity and increases patient compliance. Problems in the treatment of both hypertension, a lifetime disorder, and opiate addiction are associated with compliance. The goal of this research is to develop a subcutaneously injectable system which can release drug at constant rates over a long period of time. 

Reasonable convenience and ease of product use to assure patient compliance with prescribed dosages... 

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