Compliance refers to the observance of certain specifications of different definition. A good relationship between the parties involved is a basic prerequisite for a positive implementation in everyday life with effects on behavior and the future. Therefore, the paternalistic relationship between doctor and patient is replaced by modern behavioral methods in modern curricula and textbooks.
What is compliance?
In medicine, the term compliance is used regarding the cooperative behavior of patients in relation to the prescribed therapy. Thus, in the medical field, it can also be defined as “adherence to therapy.” This comes into play particularly in chronically ill people with regard to taking medication, but also in adherence to prescribed diets or recommended changes in certain lifestyles. Compliance is subdivided into five areas (dimensions):
- Socio-economic factors (level of education / poverty).
- Patient-dependent factors (forgetfulness / knowledge / ability to self-organize).
- Disease-related factors (symptoms / perceived benefit / concurrent depression).
- Therapy-related factors (side effects / complexity of administration).
- Health system and therapist-dependent factors (reimbursement / treatment options / communication).
Patients certified as having good compliance consistently follow medical advice. Non-compliance is certified patients who do not follow / comply with medical advice and therapeutic advice.
Function and task
Positive compliance behavior is based on a good doctor-patient relationship. Within this important relationship, communication should be in a language that the patient can understand. Unfortunately, the paternalistic doctor-patient relationship, borne of medical authority, is still practiced by some physicians today. In modern medical education, this behavior is counteracted in favor of open and understandable language through appropriate textbooks and curricula. For optimized compliance behavior, comprehensible communication between doctor and patient, but also between therapist or pharmacist and patient, contains not only information about the diagnosis or the underlying disease. Rather, it is also about the meaning and purpose of the prescribed therapy and the prescribed medication with the prospect of a better quality of life through improved health. In addition, an open relationship with the patient promotes his or her ability to self-organize. Another major advantage is that any existing risks for non-compliance behavior can be quickly identified by the professionals. These include recurrences (relapse of a disease) and signs of forgetfulness. A good example is the medication box. Patients keep track of their medications more easily, don’t feel overwhelmed as easily, and feel like they have a say in their treatment. They enjoy the feeling of being able to exert a positive influence. And this is precisely an almost invaluable advantage for patient compliance behavior. Compliance behavior is also characterized by openness in the context of therapeutic measures. Questions such as “Why do I have to do this? Why should I go to this therapy every day? How long do I have to do this therapy?” are openly discussed and explained in an understandable way so that the patient recognizes the meaning and purpose and actively engages. Reliable compliance, even by people who no longer think along in such a differentiated way and can only structure themselves to a limited extent, is implemented with aids as part of a functioning compliance. These include above all:
- Attention of doctors and nurses
- A constant exchange of information
- Offers of simplification methods such as (electronic) calendars, tablet boxes and
Compliance reminder systems
- Learning monitoring methods such as self-measurement of blood pressure and blood glucose or administration of insulin and independent weight control
- MEMS (tablet withdrawal measured electronically at home).
Diseases and ailments
Non-compliance, the failure to follow medical advice as well as the failure to fulfill therapeutically required duties, is divided into an intentional and an unintentional approach. It should be noted at the outset that the unintentional form is far more common and is mainly due to patient forgetfulness. Other reasons for non-compliant behavior to medical recommendations consist of:
- Fear of the side effects, which are too massive for many people.
- Stress due to various causes
- An uncomfortable way of taking medication
- Too high costs for therapy and / or medication
- The subsiding of symptoms (feel good again)
Other factors for rejecting behavior may include:
- Insufficient information about one’s own disease
- Lack of understanding regarding the consequences
- Insufficient knowledge about the effect of the prescribed medication.
- Other ethical attitudes (e.g. religious prohibition of blood transfusion).
Factors based on patient insight, such as reducing obesity, stopping tobacco use, or incorporating more exercise into daily life, are also triggers for noncompliance behavior. In this regard, patients often lack insight, the will to break down barriers, and the willingness to accept advice from professionals. Depending on the underlying disease, this can lead to further disease symptoms, a lower quality of life, and an increased risk of mortality. A direct relationship has been demonstrated between mortality (death rate) and reliable medication use of statins and beta-blockers by patients who have suffered a myocardial infarction. Further disease symptoms and lower life expectancy are the result, together with unnecessary treatment and an often not insignificant increase in costs, including additional hospitalization.
