eMedicineLive

Non compliance with recommended medication by patients is a significant issue that affects the patient’s health and well being. In diseases like tuberculosis, primary non-compliance leads to significant public health problem including multi-drug resistance and spread of the infection to others. Non-adherence could be due to patient related factors or physician related factors. Lack of effective communication and good physician patient relationship has been one of the prime reasons for non-compliance.

Asthma is a chronic disease that is estimated to afflict 300 million people worldwide and a significant proportion of people in India. Population based studies have consistently shown that asthma is undertreated and compliance with asthma medications is very low. Non compliance leads to sub-optimal management of asthma. The effective management of asthma in India is complicated by several factors including low socioeconomic condition, low health literacy and non-standard alternative medical practices.

The quality of health care delivery in India is considered to be low compared to the western standards. This is attributable to various reasons including the low socio-economic and educational status of the significant proportion of population. Inspite of the current economic growth and projected to be a global political and economic power, significant proportion of the population do not have access to primary health care. Significant proportion of the people from the low socioeconomic group are treated by native medicine practitioners, pharmacy store personnel, quacks and alternative medicine practitioners. In such a setting it is difficult to assess if the patients with asthma are diagnosed properly, given appropriate medications and if the patients are adhering to the medications. Hence there are significant challenges in the management of asthma from the public health point of view.

One of those challenges is the issue of compliance with patients with diagnosed asthma. In general several asthmatics overestimate the level of control of asthma by tolerating substantial asthma symptoms.It is also documented that person who provides the health care influences the compliance and non-compliance in asthmatics. ICS was associated with lower risk of inpatient/ emergency department visits. Hence adherence to prescribed regimen containing ICS may bring down overall cost associated with asthma. Access to inhaled corticosteroids is key to improving asthma management in India.

Studies reveal that the use of inhalers in India is low. Several patients take asthma medications only during acute exacerbations. Hence there are possibly huge lacunae in the care delivered to the asthmatic patients. Several studies have shown that even in western countries with better health care delivery and better socioeconomic and educational situation, the issue of non-compliance with the medications is enormous. Studies which gives insights into the cause of non-adherence would give us a chance to retify the correctable cause and initiate interventions of the correcting other including appropriate patient education.