Patient Compliance With Medications: Issues and Opportunities

Health care, including most psychiatric care, is largely organized around prescribing medication to manage illness, but while so much energy is focused on prescribing, more often than most providers consider, patients never fill or only occasionally take the prescribed medication. Although we have known about this problem for decades, the issue remains underaddressed. Patient Compliance With Medications takes a very thorough and thoughtful look at this issue, addressing the scope of noncompliance, what we know about the factors that contribute to noncompliance, theoretical models that have been applied to this problem, and the current state of knowledge regarding successful interventions. The author, Jack Finchan, is a pharmacist who has written extensively on the issue of medication compliance and who has received numerous honors for his contributions to this field. He constructs a clear and comprehensive volume with a balance of theoretical and practical information likely to appeal to many readers.

The book opens with the author's introduction to the scope of the problem, describing noncompliance as a systems-level problem, rather than the patient's problem. He highlights the roles of the physician, pharmacist, and health system in addressing this issue. A particularly helpful chapter describes in some depth medication-related, patient-related, health professional-related and health system-related attributes that contribute to noncompliance. Another chapter describes the costs of noncompliance to the health system as a whole and in specific disease states. Definitions of noncompliance and theoretical models often applied to this issue, such as the health belief and stages of change models, provide a conceptual framework for the problem.

The author describes paths to addressing noncompliance, including the importance of open discussions about the degree and reasons for noncompliance, as well as the need to address barriers, such as economic issues, fear of adverse effects, and hopelessness about recovery. The book closes with a chapter that emphasizes the prescriber's role in being thoughtful about compliance each time he or she adjusts or adds medications. It provides the reader with ten specific questions to be asked before prescribing a new medication for a patient, which are intended to increase the likelihood that any new medication is added only if it is truly warranted.

Noncompliance is a universal issue in health care, and, as this book describes, one that prescribers often leave unaddressed. This book would be readily accessible to a wide range of health care professionals, including physicians, advanced practice nurses, pharmacists, nurses, and students. Notably, although this book does not focus specifically on adherence to psychiatric medications, special attention is paid to the impact of psychiatric disorders on compliance and the importance of compliance in the treatment of serious mental illness. The theoretical and practical information described can be readily applied to addressing compliance with both psychiatric and nonpsychiatric medication in most practice settings.