The above examples illustrate the extent of the problem of therapeutic non-compliance and why it should be a concern to all healthcare providers.
As previously mentioned, if the patients do not follow or adhere to the treatment plan faithfully, the intended beneficial effects of even the most carefully and scientifically-based treatment plan will not be realized. More than 20 studies published in the past few years found that compliance with oral medication for type 2 diabetes mellitus ranged from 65% to 85% ( Rubin 2005). For the management of diabetes, the rate of compliance among patients to diet varied from 25% to 65%, and for insulin administration was about 20% ( Cerkoney and Hart 1980). Among adolescent outpatients with cancer, the rate of compliance with medication was reported to be 41%, while among teenagers with cancer it was higher at between 41% and 53% ( Tebbi et al 1986). In one US study, Monane et al found that antihypertensive compliance averaged 49%, and only 23% of the patients had good compliance levels of 80% or higher ( Monane et al 1996).
Patients’ compliance with medication therapy for hypertension was reported to vary between 50% and 70% ( Sabaté 2003). Estimates showed that almost 50% of the prescription drugs for the prevention of bronchial asthma were not taken as prescribed ( Sabaté 2003). Furthermore, the rates of non-compliance with different types of treatment also differ greatly. The rate of compliance for short-term therapy was much higher at between 70% and 80%, while the compliance with lifestyle changes was the lowest at 20%–30% ( DiMatteo 1995). Generally speaking, it was estimated that the compliance rate of long-term medication therapies was between 40% and 50%. In order to evaluate the possible impact of therapeutic non-compliance on clinical outcomes, numerous studies using various methods have been conducted in the United States (USA), United Kingdom (UK), Australia, Canada and other countries to evaluate the rate of therapeutic compliance in different diseases and different patient populations. Therapeutic compliance not only includes patient compliance with medication but also with diet, exercise, or life style changes. Hence, therapeutic compliance has been a topic of clinical concern since the 1970s due to the widespread nature of non-compliance with therapy. This shortfall may also have serious and detrimental effects from the perspective of disease management. However, despite all the best intention and efforts on the part of the healthcare professionals, those outcomes might not be achievable if the patients are non-compliant.
These desired outcomes are part and parcel of the objectives in the management of the diseases or conditions. The ultimate aim of any prescribed medical therapy is to achieve certain desired outcomes in the patients concerned.
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