Ways to Improve Compliance

People are more likely to comply if they have a good relationship with their doctor and pharmacist. Such relationships involve two-way communication.

Communication can start with an information exchange. By asking questions, people can come to terms with the severity of their disorder, intelligently weigh the advantages and disadvantages of a treatment plan, and ensure that they understand their situation correctly. By discussing concerns, people can learn that denial of their disorder and misconceptions about their treatment can lead to forgetting to take drugs as directed, resulting in unwanted effects. Doctors and pharmacists can encourage compliance by providing clear explanations about how to take the drugs, why the drugs are necessary, and what to expect during treatment. When people know what to expect from a drug, good and bad, they and the health care practitioners involved in their care can better judge how well the drug is working and whether potentially serious problems are developing. Written instructions help people avoid mistakes caused by poor recall of their discussions with the doctor and pharmacist.

Good communication is important when people have more than one health care practitioner because it ensures that all practitioners know all the drugs prescribed by the others, and an integrated treatment plan can be developed. Such a plan can help reduce the number of side effects and drug-drug interactions and possibly result in a simpler drug regimen.

When people participate in decisions about their treatment plan, they are more likely to comply. By participating, people take responsibility for the plan and are therefore more likely to follow it. Taking responsibility includes helping monitor the good and bad effects of treatment and discussing concerns with at least one of their health care practitioners--doctor, physician assistant, pharmacist, or nurse. People should report unwanted or unexpected effects to a health care practitioner rather than adjust a drug dose or discontinue a drug on their own. When a person has good reasons for not following a plan and explains them, the doctor or other health care practitioner can usually make an appropriate adjustment.

People are also more likely to comply if they believe that their health care practitioner cares whether or not they follow the plan. People who receive explanations from a concerned practitioner are more likely to be satisfied with the care they receive and to like the practitioner more; the more they like the practitioner, the more likely they are to comply.

Obtaining all drugs from one pharmacist can also help, because pharmacists keep computerized records of the drugs a person is taking and can monitor them for possible duplication and for drug-drug interactions. People taking prescription drugs should inform their pharmacist about what over-the-counter drugs and dietary supplements (such as medicinal herbs) they are taking. Also, people can ask the pharmacist about what to expect from a drug, how to take it correctly, and which drugs interact with each other.

Support groups for people with particular disorders are often available. These groups can often reinforce the importance of following a treatment plan and provide suggestions for coping with problems. Names and telephone numbers of support groups can be obtained through local hospitals and community councils (see Appendix IV).

Memory aids can help people remember to take their drugs. For example, reminder cards can be placed in different areas of the home, or taking a drug can be associated with a specific daily task, such as brushing the teeth. A wristwatch that beeps can be used as a reminder of when to take a drug. A health care practitioner or the person can mark the drug dose and the time of day to take it on a calendar; when the drug is taken, the person checks the appropriate space.

A pharmacist can provide containers that help people take drugs as instructed. Daily doses for a month may be packaged in a blister pack marked with calendar days, so that people can keep track of doses taken by noting the empty spaces. Caps or stickers the same color as the tablet or capsule can be placed on each container to help people match the drug to the instructions on the container. Multicompartment boxes or trays that contain compartments for each day of the week and/or for different times of each day can be used. The person or caregiver fills the compartments on a regular basis, such as at the beginning of each week. By looking at the box, the person can determine whether the pills have been taken.

Containers with a computerized cap are available. These caps beep or flash at dosing time and can record how many times a container is opened each day and how many hours since the container was last opened. Another alternative is a paging service with a beeper (available from subscriber-based telecommunications companies).