Why a full dose means a safer you
Jun 22, 2008
WHEN Richard, a 24-year-old man, was given a cocktail of drugs, he did not take the full dose. He suffered from cough and chest pain and was given Amoxyl (two capsules after eight hours for five days) and Panadol (two tablets every after eight hours for three days).
By Robert Zavuga
WHEN Richard, a 24-year-old man, was given a cocktail of drugs, he did not take the full dose. He suffered from cough and chest pain and was given Amoxyl (two capsules after eight hours for five days) and Panadol (two tablets every after eight hours for three days).
After three days, Richard felt better and abandoned his treatment. He may have been relieved, but this is dangerous. It makes the disease-causing germs to get used to the medicine such that the next time he gets a cough, it would require him to take a higher dose or a stronger drug.
This phenomenon is called drug resistance. A survey, led by Dr. Moses Joloba, a lecturer at Makerere University Medical School in 2003, revealed that antibiotic resistance in Kampala was on the increase.
In fact, it was estimated that 83.5% of the study population was resistant to penicillin; also the same percentage for septrin. It was concluded that this tragedy was caused by patients not taking the full course of prescribed drugs.
It is also estimated that the Government and healthcare investors lose billions of shillings annually due patients who do not comply with medication.
Compliance has been defined as the extent to which the patient’s behaviour (in terms of taking medication, following diets or lifestyle changes) coincides with medical care.
Several studies have repeatedly shown that the patients’ failure to comply with treatment guidelines is the major cause of drug resistance. This means drugs have one feature in common; none of them works when not taken.
Non-compliance
Many methods have been used to estimate the extent to which patients fail to take their medication and investigations in these studies have shown that non-compliance trends run between 20-50% for most medications; and tend to be worse with long-term treatment.
Swallowing of the complete course of prescribed drugs is known to be particularly low in chronic conditions where patients have to take medication frequently over a long period of time.
Reported cases include conditions like hypertension, diabetes, asthma, HIV, tuberculosis and the mentally-ill patients.
Dr. Daniel Ssemakula of Mulago Hospital says in such long-term treatment, patients get fed up of swallowing drugs since they believe that their hope of being disease-free is non-existent. They lack motivation.
Improving compliance
Failure to take the prescribed medication points to a breach of contract established between the health worker and patient.
In order for patients to comply, the doctor and patient should recognise and respect each other. The following can be done to raise the level of compliance to treatment.
The doctor-patient relationship
The relationship between a patient and doctor should be one of friendship so that trust and respect is created. This should continue throughout the course of treatment.
However, in Uganda where the doctor:patient ratio is 1:24,725, it is difficult for doctors to create such a relationship, but the patients can push for the relationship. It is important for them to get the doctor’s contact so that they give him or her an update on their health.
Doctors should give simple medication
A dose is an important factor in patient compliance. An individual is less likely to take medication four times daily for a month.
This can be substituted with pills taken once one a day. However, many new drug combinations which represent the simplified drug regimen are expensive, posing a challenge in health service delivery. Healthcare institutions can review patients who are taking many drugs regularly for a long time at least twice a month.
Enlist additional support staff
Enlisting additional support to the patient in the course of treatment, especially their spouses, children and friends is important.
This reminds the patients to take their pills and gives them emotional support, especially in long-term treatment of diseases like diabetes, hypertension, HIV/AIDS and mental illness.
Consultation
Patients are equal participants in consultation. They have a will to decide whether or not to follow the prescription. Patients should be listened to and given an opportunity to express their concerns.
Treatment options, too, should be explained and negotiated in partnership with the patient. Explanations should be done at the level of the patient’s understanding.
The goal of shared decision-making is to ensure that both the doctor and patient have an equal commitment to the treatment plan.
Problems of Non-Compliance
When Joan visited a clinic in Kampala complaining of backache, she was given drugs, but the nurse did not explain the purpose of each drug.
As a result, she abandoned the treatment and sought help from a traditional healer. Some people assume that the doctor’s role is to prescribe medicine and tell the patient how to take it.
However, patients are not passive pill takers, they should make a choice on whether or not to take the medication. Who take medications for different reasons.
Medicine may be a symbol of our illness or control of it. Patients need to discuss their fears, beliefs and expectations with health workers.
WHEN Richard, a 24-year-old man, was given a cocktail of drugs, he did not take the full dose. He suffered from cough and chest pain and was given Amoxyl (two capsules after eight hours for five days) and Panadol (two tablets every after eight hours for three days).
After three days, Richard felt better and abandoned his treatment. He may have been relieved, but this is dangerous. It makes the disease-causing germs to get used to the medicine such that the next time he gets a cough, it would require him to take a higher dose or a stronger drug.
This phenomenon is called drug resistance. A survey, led by Dr. Moses Joloba, a lecturer at Makerere University Medical School in 2003, revealed that antibiotic resistance in Kampala was on the increase.
In fact, it was estimated that 83.5% of the study population was resistant to penicillin; also the same percentage for septrin. It was concluded that this tragedy was caused by patients not taking the full course of prescribed drugs.
It is also estimated that the Government and healthcare investors lose billions of shillings annually due patients who do not comply with medication.
Compliance has been defined as the extent to which the patient’s behaviour (in terms of taking medication, following diets or lifestyle changes) coincides with medical care.
Several studies have repeatedly shown that the patients’ failure to comply with treatment guidelines is the major cause of drug resistance. This means drugs have one feature in common; none of them works when not taken.
Non-compliance
Many methods have been used to estimate the extent to which patients fail to take their medication and investigations in these studies have shown that non-compliance trends run between 20-50% for most medications; and tend to be worse with long-term treatment.
Swallowing of the complete course of prescribed drugs is known to be particularly low in chronic conditions where patients have to take medication frequently over a long period of time.
Reported cases include conditions like hypertension, diabetes, asthma, HIV, tuberculosis and the mentally-ill patients.
Dr. Daniel Ssemakula of Mulago Hospital says in such long-term treatment, patients get fed up of swallowing drugs since they believe that their hope of being disease-free is non-existent. They lack motivation.
Improving compliance
Failure to take the prescribed medication points to a breach of contract established between the health worker and patient.
In order for patients to comply, the doctor and patient should recognise and respect each other. The following can be done to raise the level of compliance to treatment.
The doctor-patient relationship
The relationship between a patient and doctor should be one of friendship so that trust and respect is created. This should continue throughout the course of treatment.
However, in Uganda where the doctor:patient ratio is 1:24,725, it is difficult for doctors to create such a relationship, but the patients can push for the relationship. It is important for them to get the doctor’s contact so that they give him or her an update on their health.
Doctors should give simple medication
A dose is an important factor in patient compliance. An individual is less likely to take medication four times daily for a month.
This can be substituted with pills taken once one a day. However, many new drug combinations which represent the simplified drug regimen are expensive, posing a challenge in health service delivery. Healthcare institutions can review patients who are taking many drugs regularly for a long time at least twice a month.
Enlist additional support staff
Enlisting additional support to the patient in the course of treatment, especially their spouses, children and friends is important.
This reminds the patients to take their pills and gives them emotional support, especially in long-term treatment of diseases like diabetes, hypertension, HIV/AIDS and mental illness.
Consultation
Patients are equal participants in consultation. They have a will to decide whether or not to follow the prescription. Patients should be listened to and given an opportunity to express their concerns.
Treatment options, too, should be explained and negotiated in partnership with the patient. Explanations should be done at the level of the patient’s understanding.
The goal of shared decision-making is to ensure that both the doctor and patient have an equal commitment to the treatment plan.
Problems of Non-Compliance
When Joan visited a clinic in Kampala complaining of backache, she was given drugs, but the nurse did not explain the purpose of each drug.
As a result, she abandoned the treatment and sought help from a traditional healer. Some people assume that the doctor’s role is to prescribe medicine and tell the patient how to take it.
However, patients are not passive pill takers, they should make a choice on whether or not to take the medication. Who take medications for different reasons.
Medicine may be a symbol of our illness or control of it. Patients need to discuss their fears, beliefs and expectations with health workers.