AlignMap

This One Is About Adherence to COPD Treatment

Source
Patient Adherence In COPD
Bourbeau J, Bartlett SJ.,
Thorax. 2008 Sep;63(9):831-8

The Review

First, I must point out that Patient Adherence In COPD is a well-researched, well-written, accurate review of – well, patient adherence in COPD. It is, in fact, superior to most reviews, eschewing, for example, oversimplified, easy conclusions and recognizing the limitations of the research.

I chose this specific review, in fact, to serve as context for a discussion of the inherent problems with the current concept of patient compliance because it is competently done. I want to emphasize, as I suggested in Patient Compliance Research – Finding Precisely Accurate Answers To The Wrong Question?, that the issue isn’t the quality of the research or the thoroughness of the review; the issue is whether we’re asking the right questions.

The key  points of the article follows.

The Abstract

Section Headings

• Adherence: an overview (compliance, adherence and concordance)
• Medication and regimen factors
• Patient factors
• Healthcare provider and caregiver factors
• Patient adherence in the treatment of COPD: non-adherence to medication in COPD, suboptimal adherence to non-drug therapy in COPD, strategies to enhance adherence

Excerpt From Results

Excerpt From The Conclusion

It’s The Same Old Song

I’m the first to declaim that the standard patient compliance review is not a bad song; in fact, it’s a song I like at lot. I’ve participated in the occasional standing ovation. Heck, if I were on American Bandstand, I’d give it a 99. It’s just that we’ve heard it before – 50 or 60 or a few hundred times.

The fundamental sheet music template for a patient compliance review, which correlates highly with  Patient Adherence In COPD – and dozens of others reviews and reports – calls for  the opening bars to offer an Overview Of Compliance, typically comprising a history of organized medicine’s positions on compliance, a discussion of Adherence Vs Compliance Vs Concordance, selected statistics illustrating fiscal costs, morbidity and mortality, and prevalence. Standard elements of the midsection of the piece include the impact of the treatment and the disorder under discussion on compliance, the impact of the patient’s individual psychology, culture, family, and other background on adherence, and the vital role of the healthcare provider. Specific Results often follow, highlighted by the percentage of population of patients being studied who are noncompliant. Then comes the big finish, AKA The Conclusion – familiar lyrics that go a little something like this: patient compliance must be addressed, there are no evidence-proven compliance enhancement strategies, and – here comes the final refrain – further study is needed.

I think that just about covers it. A great performance won’t get the author on the cover of Rolling Stone, but they could well win a place in a few medical journals.

The question for compliance fans is how much value is left to be garnered by more performances of the same power ballad.

Who believes the problem is that the patient compliance reviews and research aren’t exacting enough, aren’t thorough enough, aren’t insightful enough, … ?  Show of hands.  OK, no one believes that. Who believes that the next review of adherence among tuberculosis patients will reveal a clinical truth of significant importance?  No one? OK, how about that same review written about asthma patients, adolescents with acne, lepers over 60 years old, bloggers following a physical therapy regimen after a hip pinning, … ?

Here’s my point:
Even if one loves Motown (and I do), eventually one learns (and I did) that listening to Leonard Cohen, Bruce Springsteen, or Death Cab For Cutie offers qualities that just aren’t available from The Supremes or Gladys Knight and The Pips. Listening exclusively to the same Top 40 on the same Golden Oldies station is unlikely to expand ones musical horizons.