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UNDERSTANDING PATIENT MANAGEMENT: THE NEED FOR MEDICATION ADHERENCE AND PERSISTENCE

Educational intervention not only for the patient but for the family members as well is important. Enhancing communication between patients and the doctors is a key and effective strategy in boosting e patient’s ability to follow a medication regimen. In busy centres when doctors cannot spare the time, enlisting the use of ancillary support staff like pharmacists and nursing staff can be useful too.

Strategies to improve dosing schedule would include the use of pill boxes to organise daily doses, cues to remind patients to take medication and simplifying regimens to once daily dosing. Minimising the total number of daily doses is more effective than minimizing the total number of medications.^24,25

Other strategies, taking the example of hypertension treatment, include selecting a more forgiving agent that has less adverse effects (e.g. angiotensin receptor blockers over ACE-inhibitors and β-blockers) 24, that does not depend so much on half-life (e.g. thiazide diuretics) or that has longer half-life, where efficacy is not affected by delayed or missed dose (e.g. telmisartan over other angiotensin receptor blockers with shorter half-life).

Furthermore follow-up visits to clinics should be made convenient and efficient for the patient. Reducing waiting time is helpful and solving transportation and parking problems which is a perennial hindrance in most public hospitals and clinics would also lessen the likelihood of the patient defaulting on their treatment.

Most methods of improving adherence involved combinations of behavioural interventions and reinforcements, enhancing social and emotional support, increasing convenience of care, providing educational information about the patient’s condition and treatment and other forms of supervision and attention.

Innovative strategies that are practical for routine clinical use need to be developed e.g. handheld devices like personal digital assistants (PDAs) two way pagers, cell phones, medication vials equipped with alarms and reminders. It becomes obvious that any successful method will be complex, labour intensive and expensive.

Poor mediation adherence continues to be a huge challenge particularly in asymptomatic chronic illnesses like hypertension, dyslipidaemia. While the patient is ultimately responsible for the taking of medication, good communication, involving the patient in decision making about their care and simplifying drug regimens go a long way in improving it.

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