‘The important advances that have been made in the under- standing of the otiology of many disease states, and the devel- opment ofmany new therapeutic agents, have made it possible to euro or provide symptomatic control of many elinieal disor- ders, However, accompanying the increasing sophisti ative to diagnostic and therapeutic knowledge and been the recognition that in many cireumstances, drugs are not being used in a manner conducive to optimal benefit and safety. In many situations, efforts to maintain or improve health fall short of the goals that are considered attainable, and fre- quently, the faiure to achiove the desired outcomes has boon attributable to patient noncompliance or partial compliance. ‘With regard to the provision of health eare, the concept of compliance ean be viewed broadly, as it relates to instructions concerning diet, exercise, res, return appointments, ete, in ad- dition to the use of drugs. Howover, itis in discussions con cerning drug therapy that the designation patient compliance is employed most frequent. It ix in this context that it will be used in this discussion, and compliance can be defined as the extent to which an individual's behavior coincides with medical or health instructions/advice. Compliance with therapy implies an understanding of how the medication is to be used, as well as a positive behavior in ‘whieh the patient is motivated sufficiently to use the preseribed treatment in the manner intended, because of a perceived self- benefit and a positive outcome (eg, enhanced daily functioning and wellbeing). Some have recommended the use of the terms ‘adherence oF concordance rather than the designation compli ‘ance; havever, the latter term continues to be the most widely accepted and used. ‘The term persistence is also used to identify the duration of time over which a patient continues to take prescribed medication, Problems concerning patient complianeo with instructions have been recognized for years and, indeed, Hippocrates once cautioned, “Keep watch alsoon the fault of patients whieh often ‘makes them lie about the taking of things proscribed” Twenty- three centuries later, attaining patient compliance inthe use of their medications continues to represent a formidable chal- lenge for health eare providers When the complexity of the patient's ilinesses and the ae- tions of potent therapeutic agents are taken into account, the physician, pharmacist, and other health professionals easily an become prevecupied with the diagnosis of the disease state as wall as the solection and implications of drug therapy and assume that the patient will follow the instructions provided After all, since the medication is being provided to improve anclor maintain the patients health, why would the patient not follow instructions? Yet, studies continue to show that a large pereentage of patients fora variety ofeasons, donot take their ‘medication in the manner intended. 1782 Although some patients make a conscious decision to deviate from the prescribed regimen (ie, intentional noneomplianee), ‘many intend to take their medication aecording to instructions ‘and, in some eases, even may be unaware that their use of med- ication differs from what the prescriber intended ‘The term patient noncomplianee suggests that the patient is, at fault for the inappropriate use of medieation. Although this is ‘often the case, in a number of situations, the physician and pharmacist have not provided the patient with adequate in- structions or have not presented the instructions in sucha man- ner that the patient understands them, The most basic ques- tions regarding drug usage must be addressed—Has the patient ‘been provided with adequate instructions? Does the patient un- derstand how the medication is to be taken? Nothing should be ‘taken for granted regarding the patient’s understanding of how ‘to use medication, and appropriate steps must be taken to pro- vide patients with the information and eounseling necessary to use their medications as effectively and as safely as possible. NONCOMPLIANCE Types: ‘The situations most commonly associated with noncompliance with drug therapy include failure to have the preseription die- Pasi Seeaied, Saal Same, Ceol ecsoe Tae, feet administration, errors in the fime of administration, and premature discontinuation. ‘Some patients for whom medication has been prescribed do not even take their prescriptions toa pharmacy, and some oth rs wo do take thair prescriptions ta a pharmacy fal to pick them up when they are completed, In a survey" of consumers, 2% reaponded that they had brought prescriptions to the pharmacy but falled to pick them up. The most commen explanations for sob tang hs prasciptices ta phaaaey 6c wt picking thea: Up are that patients fecl that they have recavered from te con Uttion or otherwise dont need the medication, they think they haveasimilarmedicine at home, they don'tliketo take medicine, theeostis taohigh,or they forget to pick up the preseription fram ‘the pharmacy. Inthe many situations in whieh infection is aseo- cated with fever and local discomfort, patients already may be taking nonprescription medications, such as acetaminophen ‘The ability of thoes agents to provide some, ifnot complete, relict cfthe eymptoms ofearly infection may lead some patients to con- dude that the condition is improving or beter, and that itis not necessary to have a prescription digponsed The omission of doses % one of the most common types of noneompllanee and is more likely to oocur whon a modication is tobe administered at frequent intervals and/or for an extended period oftime. Errors of dosage include situations in which the