Why patients don’t take medicine as instructed?

One of the most common complaints that all categories of healthcare providers make is that the patients (or their care-givers) usually don’t take medicine as per instruction or advice or stop taking drugs as soon as the symptoms subside. Why this happens, despite knowing the obvious consequences has baffled the clinicians and researchers alike. The researchers have categorized three types of patients: the passive (takes the medicine as instructed), the active (takes the medicine as they thinks should be) and the rejectionist (rejects taking medication).This is all the more important because ‘prescribed medicine is the central pillar’ of modern therapeutics.

In the west, many studies have been done on to find the answer, and quite a large volume of literature exists on this issue. Taking medicines as instructed (both regards to dose and duration) or ‘compliance’ is defined as ‘the extent to which a patient’s behavior coincides with the medical or health advice given’. Major chunk of patient’s behavior falls between the two extremes (compliant or non-compliant), where some of the instructions are followed but not the others.

Research has revealed that there are a number of factors which determine whether the patient will adhere to the instructions given. Foremost among these is the ‘health belief model’ of the patient which determines patient’s attitude to the disease and the benefits of treatment intervention. If the patient is convinced about their vulnerability to the disease, its consequences to their well-being, and benefits of treatment, the patient will follow instructions for taking medicines. Usually, women of high parity, the very young, adolescents and the elderly are found to be difficult to adhere to the instructions besides people without employment or coming from the low SES. The latter is especially important for LICs like Bangladesh.

Diseases which require preventive actions, are asymptomatic, are chronic in nature, and require long-term treatment (e.g., epilepsy) make patients less compliant. Personality traits like hypochondriac-ism  also count. Other factors such as family and societal support (e.g., widowed, single, different language), doctor-patient relationship (attitude, communication, empathy etc.) and treatment regimen (form of medicines and dosage schedule) also influences patient’s treatment compliance.

Studies on patient perspective of treatment compliance reveal a decision-making model (medication-taking behavior) where patient tests the medication and then becomes either an ‘active’ or a ‘passive’ acceptor or rejects the medication altogether based upon their needs and concerns. Healthcare providers need to be sensitized to these aspects, accommodate the explanatory model of illness and health-beliefs of the patient as far as possible, prescribe medicines in such a way that it conforms to the patient’s life-style, and explain in detail the treatment regimen and its rationale to improve treatment compliance.

Interestingly, no study on treatment compliance has been done in Bangladesh so far. We can gain some insights from what has been found in studies from the West, but need to re-visit our situation, specific to our culture Bangladesh and find appropriate strategies to address these.