HOW TO IMPROVE PATIENT COMPLIANCE - THERAPEUTIC PROTOCOLS, COMPLIANCE ASSESSMENTS, RISKS, PROPOSED IMPROVEMENTS

In practice the term compliance is used to describe the patient's willingness to follow prescribed antituberculosis treatment, independently of where the infection is located. The term in fact applies to the full series of decisions concerning the patient, his or her social background, the relationship with the prescriber and the method of delivery of the drugs. All of these elements should be taken into account when compliance is analysed. Treatment regiments must comply with the norms in primary treatment and with appropriate guidelines in the case of retreatment (drug sensitivity, combinations to avoid resistance, etc...). The degree of compliance diminishes with the duration of treatment. It includes a number of types of failures : failure to take all of the drugs; increased or shortened duration of treatment; irregular drug-taking; incorrect dosage; drugs not taken as directed (specific times and combinations, on an empty stomach). Compliance measures can be direct, qualitative or quantitative, and more costly; they can be indirect, using means of ensuring that drugs are taken correctly. Certain risks of non-compliance can be due to unsatisfactory dialogue or to a patient's personality; they can also depend on the administrative conditions of drug delivery and surveillance. Improved contact with medical personnel, indirect, or better direct, observance of treatment (DOT), and the application of incentive measures such as compensation or payment are the most effective ways of improving compliance. Non-compliance is in fact more common than imagined; an important obstacle to effective tuberculosis control, it can occur in all areas (age, gender, profession, marital status, social category, revenue or education). However the profile of certain patients and situations justifies the need for increased vigilance (individuals or groups at risk in industrialised countries).