PHARMACOECONOMICS

Noncompliance from the patient's viewpoint

Noncompliance with prescribed medication is viewed as undesirable and irrational from the medical perspective. However, from the patient's point of view, noncompliance may often be seen as preferable and rational. And to better understand medication compliance, outcomes research on compliance should recognise the patient's perspective, in the opinion of Drs Lisa Stockwell Morris and Richard Schulz from the US.

QOLeffects Available literature suggests that patients

evaluate the usefulness of their prescribed medication not only by clinical efficacy, but also by the way it affects their quality of life. When desired treatment outcomes are achieved (e.g. pain relief or resumption of normal activities) compliance may actually improve. But when these outcomes are not reached, noncompliance can occur as the medica­tion is considered ineffective by patients, even if clinical measures of improvement are detected. Furthermore, adverse effects which interfere with daily life can also lead to noncompliance.

Medicatiom self-regulated Patients often self-regulate their medications by

reducing or increasing daily doses, or by skipping doses or taking extra doses under certain situations. These steps are taken in an effort to control their symptoms better, reduce adverse effects or to have some degree of control OVer their lives. Medications may also be used by some patients to test the presence or severity of the condition for which it was prescribed. Other patients are noncompliant simply because a particular treatment does not fit into their everyday life.

The cost of medications and insurance status seem to have inconsistent effects on compliance. However, it appears that noncompliance is more likely in patients with perceived financial distress. Morris LS, Schulz RM. Medication compliance: the patient's perspective. Clinical Therapeutics 15: 593-606, May-Jun 1993

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ISSN 0156-27031931080HI091$1.rxf' Adls International Ltd

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INPHARMAe 7 Aug 1993