DETECTION PROCESSES OF PATIENT NON-COMPLIANCE

Definition of compliance/adherence

Ø      Compliance (Sometimes called adherence) is the extent to which patients follow treatment instructions of the prescription prescribed by a Pharmacist or a Physician.

v      What is patient Non compliance?

Ø      The term  patient Non compliance suggests that the patient is at fault for the inappropriate  use of medication . It means the patient fails to take the medication as prescribed.

Categories of Non-compliance?

q      Reasons offered:

→        too busy

→        too complex

→        forgetfulness

→        schedule changes

→        psychological distress

→        running out of medicines

ü      UNWITTING

    -  Prescriber Doctor/Pharmacist and patient believe patient is complying appropriately

q      Normally resulting from:

→     poor understanding of regimen(i.e. Errors of dosage)

→     incorrect administration technique

→      language obstructions

→     cognitive impairment (I .e. Errors to adjust the time of medication, omission of dosage)

ü      INTENTIONAL

q      Prescription:

→      feeling better

→      believe medicine not required

→      believe regimen ineffective

→      regimen too complex

→      fear of addiction, side effects, toxicity

→      medicines too expensive

→     Detection method can be of two types

      1.   Indirect method

       2.   Direct method

           Self Report

Ø      Clients tend to answer yes to questions posed to them by their health care provider to please them. Based upon this observation, the questions have been designed so that an adherent client gives a no response.

               Visual Analogue Scale (VAS)

               Pill Identification Test (PIT)

               Pill Count

v      Did the client bring his or her medication containers back?

         Yes/No

Calculated percentage adherence

      % Adherence = {(Dispensed – Returned) / Expected to be taken} X 100

2.  Direct method

            - Biological marker

            -Tracer compound

            -Determination of drug concentration in biological fluid.

Tracer compounds

Ø      Tracer compounds have long half lives

Ø      Have been mixed to drugs and measured in biological fluids as pharmacological indicators of compliance.

      Machine uses in this purpose

Abbott AxSYM Immunochemical Analyzer (Processes upto 120 tests per hour)

Uses:

ü      Therapeutic drug monitoring

ü      serology test(The scientific study of serum & their reaction) 

Determination of drug concentration in biological fluid.

ü      Finally,  compliance also has been detected through determination of drug concentrations in patients’ biological fluids.

ü      The use of physico-chemical techniques such as spectophotometry , colorimetry as well as polarography has often required a separation of the drug from interfering materials present in the biological fluid.

SEMISOLIDPREPARATION CREAM

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