A Complex System Perspective on Medication Compliance: Information for Healthcare Providers
Jos M. Koomen
Medication compliance is a classic problem for patients and healthcare providers and little progress has been made in improving it. The objective of this review is to enhance the understanding of medication compliance by means of a complex systems approach. The complex system approach includes seven underlying variables that are most likely to influence medication compliance: 1. Knowledge: understanding how to use medication may be essential for compliance, but knowledge of disease or its treatment may also enhance concerns regarding prognosis or adverse effects of medication. However, various studies have failed to show a positive relationship between additional knowledge of the disease or its management and improved medication compliance. 2. Illness beliefs: attitudes and beliefs about disease are crucial for compliance, but a patient's beliefs may be conflicting. Moreover, compliance behavior is influenced by automatic, environmentally controlled cues, or by irrational beliefs or rules of thumb, rather than logical reasoning. 3. Symptom perception: accurate perception may be essential for compliance. 4. Anxiety: modest concerns about health improve compliance whereas anxiety or indifference with regard to symptoms can have adverse effects on compliance. 5. Control of symptoms and/or disease and self-efficacy: confidence regarding the management of health problems may be desirable in improving compliance. However, patients with a high sense of control may underuse medications. The exact role of self-efficacy in compliance is unclear. 6. Medication efficacy: patients should perceive that the relief of symptoms or control of disease with a medication is in excess of its adverse effects in order for good compliance. 7. Patient-physician/pharmacist congruence: patients should feel that they have the support of their physician and pharmacist in managing their disease. In addition to these variables, social support is commonly advocated as a determinant of medication compliance. In conclusion, mutual influences, interactions and nonlinear features of the different variables mentioned above warrant a holistic approach from healthcare providers to the analysis and improvement of medication compliance.
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