In addition to science, medicine is also an art. The role of adherence both on the part of the patient and on the part of the medical community is key in the category of treatment, so that if this cultural reality is not paid attention to, medicine will be ineffective and these treatment failures will increase the disappointment of patients and increase morbidity and mortality. be made We should consider the treatment to be
bio-socio-psychological and knowing only pathobiology and medicinal mechanism is not enough and non-adherence in the West is more than 50% and in our country it is definitely still higher . With physical and social health and the improvement of the quality of life related to health, in fact, high self-management is the result of good adherence and self-increasing. Previously , the patient’s relationship with the doctor was complicit, until the patient’s compatibility and pure compliance with the medicine and the doctors’ orders. The patient who obeyed the orders better was approved more and the basis of the training of doctors and the society was the same principle and the decision of the treatment was only the responsibility of the doctor . patients in the direction of better treatment and, more importantly, more correct prevention, and treatment and prevention decision-making is the responsibility of both the doctor and the patient, obtaining the agreement and increasing the continuous cooperation of patients is one of the principles of the new attitude, the adaptability of the doctor to the patient’s personality and understanding He and his preferences and his other co-morbidities, etc. are added to the diagnosis and evaluation of the severity and duration of the disease, and it is necessary to pay attention to the economy, social, mental and even spiritual conditions of the patients . and following them and taking the prescription and taking the medicine correctly is in the treatment of the primary attack of the disease, secondary adherence is the continuation of education and action to the presented materials and continuing to take the drugs to prevent the recurrence or return of the disease, and the improvement of adherence and keeping it from the primary onset It is more important because there is a need to continue to follow the orders and medicines when the patient does not appear to have an attack and the urge to return to a risky life is strong and tempting .
The level of the disease,
- the type of the disease and its importance, the probability of the attacks being urgent and death, and the severity
of the chronicity,
all patients have better adherence in the morning than in the evening and at night, and they
are more bound in the beginning of the disease than later in the course of the disease, and people who have several co-morbidities are less cooperative in adherence. - Children’s patient level
: inability and stubbornness and… old age: forgetfulness of young people: fitness and peer pressure,
beliefs and expectations, fears, feelings and motivations, behavior and pity,
previous treatment failure and patient experience,
strict abstinence diets and previous habits and interests of patients
at the level Literacy and the level of understanding, the power of analysis and the ability to apply/summarize data and create science and certain beliefs and change the behavior of
a minority or an immigrant,
having sufficient family and social support/family differences,
having special preferences or a certain lifestyle,
addiction to smoking, hookah, drugs Drugs and alcohol
, having pets,
poverty/income,
stress, obsession and depression - drug level,
price/taste, shape and size of the drug, and the method of administration,
expectations of the drug, it should be cheap, it should work quickly, it should be used once a day or once at all, it should not have any side effects, it should last a long time, and even it should be permanent. - The level of medical and healthcare service providers: level of doctor/treatment staff/pharmacist
level of literacy/level of experience/ability to create effective communication/the art of teaching each person (expressing in a simple and understandable way)/creating trust and showing empathy according to thoughts, attitudes and feelings/ The appearance of the doctor, the place of medicine and the rest of the staff - The level of national health insurances and policies,
macroeconomic and health policies, the level of literacy and expectations of the medical staff and doctors, and effective insurances, the general culture of the people in the field of health and diseases,
the availability of medical and sanitary necessities,
the conditions of society,
chaos, discrimination, war, immigration, marginalization.
Adherence measurement
- The patient himself reports that either writing a daily report or completing a questionnaire or face-to-face interview/sending SMS/e-mail,
people cannot or have disabilities due to age or language or culture,
all of them present themselves as more successful and cooperative or more loyal than reality. Fear
of a doctor’s fight or fear of less attention from the doctor - by others,
electronic devices such as the number of drug boxes opened/repeated prescriptions/certificates of others - Indirectly, being regular in appointments/having good manners with everyone/explaining treatment plans and knowing the names of medicines/occurrence of family discord in the presence of the doctor/depression or stress
The conclusion is that
each person’s special education and compliance with ethics and creating security is the best guide to adherence.