Hippokratia 2006; 10(2): 51-59
P.N Ziroyannis, P Vamvakari
Nephrology Dpt, General Hospital of Athens, Athens, Greece
Opportunities to improve compliance.Opportunities to improve compliance. It is well known that efficacy of a specific treatment may be evaluated only when there is compliance with the treatment. The term compliance is customarily used to refer to the degree to which patients follow the therapeutic recommendations of a health care provider. Recently there has been renewed interest in this area due to technical advances and a new appreciation of its importance as assessed by outcomes research. In fact, research has shown that the rates of non-compliance are often high, ranging from 30 to 60 percent for all types of medical therapies - even among those patients who are seriously ill. Despite the lack of uniform criteria for measuring compliance in the interpretation of reported rates, there is little doubt that overall compliance with prescribed regimens is suboptimal. Noncompliance among ESRD patients undergoing renal replacement therapy is a clinical challenge. Studies have reported noncompliance rates as high as 86% with ESRD patients’ full regimen, including medications, fluid restrictions, dietary restrictions and consistency in returning/staying for treatments. To evaluate adherence to treatment, it should be possible to measure it simply and repeatedly. Outcomes researchers have rediscovered the importance of compliance, and have been able to demonstrate in long-term studies, including the Beta-Blocker Heart Attack Trial, the Medical Research Council Trial in the Elderly, and the Acute Infarction Ramipril Efficacy Study, that compliance with therapy is a major determinant of a beneficial outcome. The study of compliance has been improved by the implantation-based memory chips that are inserted into the caps of medication containers, which “remember” the times and dates when the container is opened, presumably to dispense a pill. This has provided a new gold standard for the estimation of compliance, which formerly was based on pill counting or other less accurate measures.