Re: E-DRUG: The terms compliance and patient

["B. Futter" <B.Futter@ru.ac.za>]

E-DRUG: The terms compliance and patient (cont)
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John has raised many excellent points in his discussion on 
efficacy/ compliance. If one uses an analogy, an empowered 
passenger is able to decide whether to get to the airport in time.  
However, if he arrives late, the plane will have gone. The 
concordance of the passenger's behaviour with the behaviour 
recommended by the travel agent will ensure that the travel 
outcome will be achieved.  If the passenger decides on another 
course of behaviour, the consequences are no longer the problem 
of the travel agent and this is where the analogy ends.  

If a patient decides to take a medication at a time, dose etc, 
different from that advised, there is a large measure of 
responsibility for the outcome that remains with the health care 
professional. In my opinion, it is encumbent on the health care 
professional to identify the ability and willingness of the patient 
(present and future) to follow the regimen and take whatever steps 
are necessary to ensure compliance/ adherance.  Would a 
pharmacist dispense medication to a child who does not 
understand how to take the medication? to a blind or illiterate 
person who could not read instructions?  to a patient who is 
unlikely to complete a course of treatment (eg.TB)?  At one 
extreme there is talk of locking up TB patients to ensure 
compliance.  

Whilst there are ethical issues involved, I believe that concordance 
is only one dimension of compliance rather than the other way 
around.

Billy
Billy Futter
Associate Professor
Faculty of Pharmacy
Rhodes University, Grahamstown, South Africa
email B.Futter@ru.ac.za
 
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