AlignMap

Beyond Compliance, Adherence, & Concordance – Supporting The Patient’s Implementation Of Optimal Treatment

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Ending The Damage Caused By The Treatment Adherence Paradigm

June 29th, 2009 · Comments Off

My post, It’s Time To Stop The Damage Caused By Today’s Patient Compliance Paradigm, went online at the eyeforpharma.com site today.

While fundamentally a summary of the preceding posts on this blog, 1 It’s Time To Stop The Damage Caused By Today’s Patient Compliance Paradigm can claim an original introduction, which, I think, is worth sharing here:

Imagine that, say,  a well known Fortune 500 manufacturer of state of the art medical devices and the Feds co-funded a $14.2 million multi–center  study at four prestigious universities to determine the  effectiveness of a newly designed stereotactic laser bloodletting* machine (with optional Facebook connection)  in treating diabetes.

Doesn’t it seem likely that a whistle-blower – or, failing that, a Senator coming up for re-election, an investigative reporter desperate for a story, a publicity-seeking Attorney General of one state or another, a gadfly shareholder, a do-gooder looking for a cause, or a Ralph Nader wannabe – would be loudly decrying the use of public and shareholder monies on a clinical trial of a treatment never shown to be of benefit to patients with this disease despite many, many years of use? One would, in fact, think that  congressional committees would be convened, newspaper stories written, blog posts posted, accusations leveled and denied, indictments brought, damage control instituted, scapegoats designated, and heads rolled.

At the least, the medical device company,  the Federal agency that handed over the bucks, and the academic institutions involved would be called upon to justify their choice of investments, i.e., explain why the limited amount of money and skilled researchers were designated to be expended on this project instead of a potentially effective therapy – or at least one that has not already proven useless.

I contend that  the now dominant  paradigm of adherence to treatment, has,  like bloodletting,  been so unsuccessful for so long (see previous posts: The Tragedy Of Patient Compliance and Patient Compliance – So Wrong For So Long)  that continuing to explore the same familiar primrose paths  of the patient compliance model  entails an intellectual responsibility to provide an explicit rationale for taking this tack.

Next: Alternatives To the Current Patient Compliance Model

The posts in this sequence have thus far focused on the why the treatment adherence paradigm is ineffective and the danger of its continued use.

As noted already, the next entries will begin a discussion of possible alternatives to the current model.

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  1. See Why The Treatment Adherence Paradigm Must Be Destroyed:  Part 1 and Part 2

Tags: Transforming Compliance

Adherence – Independent Marker Of Lower Mortality

July 7th, 2006 · Comments Off

Source:
Scot H Simpson, Dean T Eurich, Sumit R Majumdar, Rajdeep S Padwal, Ross T Tsuyuki, Janice Varney and Jeffrey A Johnson (2006) A meta-analysis of the association between adherence to drug therapy and mortality BMJ 333: 15-18

A meta-analysis of 21 studies with a total of over 46,000 participants demonstrated that those who take their medicine as prescribed, even if the medication is a placebo, have a lower risk of death than those with poor adherence. It is significant that this finding is congruent with numerous other studies of placebo over the past 50 years.

The authors speculate that patients who exhibit high levels of adherence also maintain a constellation of healthy behaviors and that this group of salubrious habits accounts for the improved mortality. Others1 extend the notion that “healing lies not in the treatment but rather in patients’ emotional and cognitive processes of ‘feeling cared for’ and ‘caring for oneself.’”

Commentary

While the correlation between adherence and health is intriguing, it begs the chicken-egg question: assuming adherence can be taught, would that learned adherence similarly enhance the health of patients who were originally noncompliant, independently of whether the medication was active or inert?


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  1. Barrett B, Muller D, Rakel D, Rabago D, Marchand L, Scheder J. Perspect Biol Med 2006;49:178-98. and Miller WR, Rollnick A. Motivational interviewing. New York: Guilford

Tags: Research