Observance… in the middle-ages, this word meant the action to observe a religious rule! Reflect today the wish of physicians to see their followed scrupulously, requirements such as the words of Saint Bernard? This applied discipline is of crucial importance for the individual and for the health of the population.
Pr Jean Doucette (Rouen) defines compliance as “the adequacy between the recommendations of the doctor and the behaviour of the patient, it concerns both tracking the prescription of medicines that boards and planning of care.” “It is also not followed treatments than drugs taken in excessive doses than prescribed”.
Sometimes consequences serious
However, two thirds of the requirements are not strictly respected: less time, less often in taken grouped in hourly irregulars… everything is possible, and for multiple diseases: AIDS has largely contributed to the dissemination of the word, with 30-40% of people “not observances”. All chronic conditions are concerned, since the symptoms are not apparent: high blood pressure, diseases metaboliques… In asthma, treatment noncompliance faces extremely serious consequences in the very short term: three quarters of asthmatic patients emergency admissions could be avoided and most of the deaths are related to deficient observance.
More treatment is long and complex, more side effects are severe, most errors are frequent. The “land” plays a role in this neglect. Sociologists cite cultural factors – some minority ethnic – or mental, including drug addicts. Generally, the requirements are not met by patients with psychiatric disorders (of anxiety to complex diseases). Seniors are very concerned, 10% of their hospital admissions are for all or part related to a drug accident. Finally the observance varies, in a same person, over time.
Individual and collective risks.
The compliance decreases the effectiveness of the treatment, is the source of adverse (for sure-dosage) or treatment failure (if under dosing). Drug withdrawal subject to serious complications in asthma or depression (risk of suicide). Less obvious but typical, the case of an antibiotic before the end of the treatment is sometimes serious. Infection risk to restart in a sneaky way, and, the germ will become “resistant” to this antibiotic, with serious consequences for the individual (the new treatment present often more adverse effects), and for the health of the populations because it is as bacteria are more difficult to treat. Moreover, of the compliance flow additional requirements, where new accidents, hospitalizations and additional investigations, with health care costs increased.