Clinical Pharmacology and Therapeutics. Группа авторов
if the patient takes a medication infrequently or not at all, then this is likely to mean that they derive less benefit and is a common reason why ‘real world’ benefits of drugs may be less than seen in clinical trials, in which adherence is usually higher.
Many factors influence adherence. Good explanation and understanding on the part of the patient of why they are being prescribed a drug and a perception that the drug will be helpful is important. Similarly important are a convenient method of administration and an absence of significant side effects. A side effect that a patient may tolerate when taking a week‐long course of antibiotics may not be tolerated if the same adverse effect occurs during long‐term prescribing for a chronic health condition such as hypertension. The effect of tablet burden and multiple prescribing is often underestimated. There is strong evidence that adherence is reduced even when prescribing two rather than one tablet and this effect is even greater if patients are taking larger numbers of tablets or multiple daily dosing. Clearly such problems cannot always be avoided, but the impact of being asked to take several tablets several times per day should not be underestimated.
A number of methods can be useful to promote good adherence. A good therapeutic relationship between patient and prescriber is helpful and explanations should be clear and appropriate. It is useful to routinely ask patients about their adherence and such questions should be asked in a non‐confrontational way that does not imply disapproval. Many patients fear telling medical professionals that they forget to take prescribed medications. Dedicated counselling can be useful, particularly if adherence is particularly difficult or appropriate. Drug administration aids such as tablet boxes or packaged doses can be very useful, particularly for patients with complex drug regimes. Many patients find that setting an alarm or reminder on a smartphone can be very helpful.
Emergency prescribing
Usually prescribing should be thoughtful and prescribing in a hurry should generally be avoided. Occasionally, an emergency situation means that delay is not possible and so prescribers should be aware of the emergency drugs that they may be asked to prescribe and any complications that may arise. These are generally taught as part of immediate and advanced life support courses.
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