Drug Adherence & Self-Medication

“Compliance” “Adherence”
 Implies “do what I tell you”, “you  Implies “you can decide to stick the
comply with my plan for you” plan”

 Indicates power dynamic between  Encourages patient autonomy &

healthcare provider (HCP) & patient shared decision-making
(World Health Organisation)
Adherence is the extent to which a person’s behaviour – taking medication,
following a diet and/or executing lifestyle changes, corresponds with agreed
recommendations from a healthcare provider.
DRUG ADHERENCE
⊹ Timing, dosage, frequency, duration of medication
⊹ In developed countries, adherence to long-term therapies for chronic illnesses is estimated to be at 50% -
lower in developing countries!

Consequences of Non-adherence
⊹ Increased morbidity
⊹ Increased hospitalisation
⊹ Increased mortality
⊹ Increased costs (direct and indirect)
⊹ Reduced quality of life
⊹ Economic impact nationally/globally
Adherence improves when…
The healthcare provider… The patient…
 Adopts a patient-centred approach  Understands the disease & treatments

 Adopts a no-blame approach  Takes part in negotiating the treatment plan

 Identifies specific barriers for each patient  Believes in the treatment plan
THE FIVE INTERACTING DIMENSIONS OF NON-ADHERENCE
1. Patient-related factors
2. Condition-related factors
3. Social and economic factors
4. Healthcare system-related factors
5. Therapy-related factors
INTERACTING DIMENSIONS OF NON-ADHERENCE
Healthcare system  Access & continuity of care
 Poorly developed health services, including insurance plans
 Poor distribution of resources
 Lack of knowledge among HCPs
 Overworked HCPs, short consultations
 Lack of awareness of strategies for improving adherence

Social & economic  Lower socioeconomic status

factors  Low education level
 Unemployment/unstable living conditions
 Lack of social support networks/family dysfunction
 Cost of transport/medication

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 Drug Adherence & Self-Medication
 Cultural beliefs about illness and treatment
Patient-related factors  Knowledge & beliefs about condition
 Motivation & confidence (selfefficacy)
 Psychosocial stress
 Anxiety about side effects of treatment
 Lack of perceived effect of treatment
 Frustration with HCPs
 Fear of dependence
 Feeling stigmatised
Condition-related  Symptoms severity
factors  Level of disability
 Rate of progression of disease
 Availability of effective treatments
 Comorbidities
Therapy-related  Complexity of treatment
factors  Duration of treatment
 Previous treatment failures
 Frequent changes in treatment
 Immediacy of beneficial effects
 Side effects & availability of medical support to deal with them
But these do not address many of the dimensions of non adherence!
Common interventions include educating the patient on medications, simplifying medications & physical
aids (eg. pill box)…

Some Better Recommendations…

⊹ Adapt communication to each patient style – use communication aids, observe non-verbal cues, consider
patient comfort & level of involvement
⊹ Increase patient involvement – use open-ended questions, encourage questioning, accept decisions
different from the HCP
⊹ Try & understand (or at least respect) patient perspective – look out for misunderstandings, put yourself in
their shoes, ask about concerns
⊹ Provide jargon-free information – discuss rather than present, check understanding regularly
⊹ Routinely assess adherence in a non-judgmental way whenever prescribing, adjusting or reviewing
medicines
– make it easier for patients to honestly report nonadherence
⊹ Improve communication between HCPs – written record of diagnosis, current medications, medications
stopped with reason, adverse reactions & allergies, potential difficulties with adherence & actions taken

SELF-MEDICATION
“Selection & use of medicines by individuals to treat self-recognised/self-diagnosed conditions/symptoms.”
“Taking of drugs, herbs or home remedies on one’s own initiative/on the recommendation of a non-
professional instead of seeking advice from a qualified HCP.”

Causes of Self-Medication
⊹ Ready access to medications, immediate relief of symptoms
⊹ Long waiting times & high costs of seeing a doctor
⊹ Dissatisfaction with quality of healthcare received
⊹ Inadequate health facilities
⊹ Familiarity with non-serious illness
⊹ Lack of health literacy
⊹ Stigmatising attitudes – self & others
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⊹ Cultural beliefs
Consequences of Self-Medication
Benefits
 Active role in own healthcare
 Increased access to medication & relief for
patient
 Reduced healthcare expenditure
 Reduced patient-doctor time (particularly
during COVID-19 pandemic)
~End😊
Frances
Drug Adherence & Self-Medication
Risks
 Misdiagnosis/masking of severe disease
 Incorrect choice of treatment
 Delays in seeking professional opinion may
lead to poorer prognosis
 Possible adverse reactions/drug interactions
 Contribution to substance use disorder
 Contribution to resistance (eg. antibiotic
resistance)
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