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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