Issue Of Noncompliance Research Articles

Attrition in maintenance therapy for recurrent depression: A preliminary report

All maintenance treatment programs are complicated by the issue of patient noncompliance. This report investigates factors contributing to noncompliance during a 2-year study designed to evaluate the efficacy of long-term antidepressant medication in patients with recurrent unipolar depression. Only 21 of 51 patients (49%) who entered maintenance treatment successfully completed this phase of the study. Fifteen patients (8 completers and 7 dropouts) were randomly selected for an interview which focused on their previous psychiatric treatment history and attitudes towards the maintenance treatment program. In addition, these patients also completed a comprehensive personality battery. Results indicate that, while both groups had similar attitudes about the treatment program, they differed significantly along personality and psychiatric treatment history variables. Dropouts scored higher than completers on a measure of hysterical personality style. They were also more likely to have received psychotherapy in previous treatment experiences and to rate it as beneficial, while completers consistently rated prior treatment, which did not include antidepressant medication, as being of no benefit whatsoever. In order to enhance patient compliance, it is important to obtain information early in treatment about patients' treatment histories and their expectations about effective treatment for depression.

Improper prescription instructions: A factor in patient compliance

Noncompliance with prescribed drug regimens represents a public health dilemma of major proportion with profound clinical implications. Various factors have been identified that influence the patient's decision to accept or reject the prescribed drug therapy. Certainly, the patient's failure to understand the nature of the illness and the importance of drug therapy have been shown to be important in the issue of noncompliance; however, new evidence indicates that inadequate and incomplete prescription instructions to the patient may be the single most important factor contributing to noncompliance in patients. In this study it was determined that incomplete, inadequate, and vague instructions for patient use occurred in substantial numbers of the 19,972 prescriptions analyzed. On the average, 7.7% of the prescriptions surveyed gave “as directed’ as the only instruction to the patients, while 14.7% of the prescriptions surveyed gave “PRN” (as needed) as all or part of the instructions. Vague directions clearly may serve to confuse the patient and motivate him not to comply with the prescribing physician's intended therapy.