Patient compliance medication management

Physical therapists and occupational therapists may help reinforce the importance of patient compliance during pharmacologic management of diabetes mellitus. Therapists can question whether patients have been taking their medications on a routine basis. Regular administration of insulin is essential in preventing a metabolic shift toward ketone body production and subsequent ketoacidosis, especially in patients with type 1 diabetes. In addition, therapists can help explain that adequate control of blood glucose not only prevents acute metabolic problems but also seems to decrease the incidence of the neurovascular complications. 

Both therapy and medication compliance can improve when the family therapist and physician have a collaborative alliance with the family, not simply the patient, and can manage the varying responses of family members over time to the patient, the illness, and the medication. 

A 5 year randomized clinical trial in the United States found that in spite of the availability of hypertensive medication, awareness promotions, and guidelines, only a third of all the hypertensive patients have their blood pressure under effective control due to noncompUance in medication. More tailored behavioral management intervention may help to improve compliance and achieve better control. 

Compliance with disulfiram therapy is often low, and both compliance and clinical outcome can be improved by supervised administration. When the drug is prescribed, the alcohol content of common nonprescription medications should be communicated to the patient some of these are listed in Table 64-3. Management with disulfiram should be initiated only when the patient has been free of alcohol for at least 24 hours. The drug may cause mild changes in liver function tests. The safety of disulfiram in pregnancy has not been demonstrated. The duration of disulfiram treatment should be individualized and determined by the patient s responsiveness and clinical improvement. The usual oral dose is 250 mg daily taken at bedtime. 

In utilizing the collaborative model in the management of bipolar disorder, as well as depression, the psychotherapist supports the inherent coping skills of the patient, assesses progress and resistance, and tracks medication compliance. The psychotherapist can then inform the psychiatrist of any changes that have occurred and/or are required, and vice versa, thereby resulting in a more comprehensive and quality-driven level of care. 

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