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INTRODUCTION BY JOHN HOSKEN

Doctors have probably been telling people to ‘keep taking the tablets’ since the earliest shamans and folk healers were first frustrated by the non-compliance of their prehistoric patients.

Today, the pharmaceutical industry is leaving an estimated US$25 billion on the shelf every year through lack of patient compliance. Events like eyeforpharma’s conference, Patient Compliance Europe, now in its third year, reflect a growing recognition of the importance of patient compliance and its impact on revenues.

Current estimates put non-compliance possibly as high as 50-70%. This is despite the well-known fact that poor compliance is associated with a lower quality of life, poor clinical outcomes, increased hospitalisations and higher overall healthcare costs. Clearly, compliance is actually synonymous with patient well-being.

So, why do people stop taking the pills? The conference drew a key distinction between types of non-compliance. There is intentional non-compliance, where patients choose not to comply with a medical regimen, reflected in unfilled prescriptions or filled prescriptions not taken, or where patients refuse treatment. And then there is unintentional compliance, where patients don’t understand the appropriate use of medicines, take them at the wrong time or the wrong dose, don’t understand the instructions or simply forget.

There are a whole range of influencing factors at work behind non-compliance. One set of factors is the patient’s general health beliefs (e.g. 'medication is dangerous', 'I will get better on my own', 'invasive or aggressive therapy is not worth it' and 'new medicines are better than old ones'). These are underpinned by the patient’s general social and economic characteristics, such as age, educational level, self-rated health (‘I feel OK so I stopped taking the tablets’), cultural and religious beliefs and, importantly, what friends and partners think about the medicines.

Addressing compliance issues means understanding consumer behaviour. How does the consumer perceive his/her problem? How bothered are they by it? What is motivating the non-compliant behaviour? What are the barriers to compliance? And what is the patient-physician dynamic?

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