How can we improve compliance in pediatric pneumology and allergology?
Not too long ago, physicians took 'compliance' or 'adherence' to mean the strict obedience of patients and parents - doing what the physician said, suggesting that the success or failure of the treatment lay entirely in the hands of the patient. But it is preferable to improve compliance rather than enforce it. As there is no single solution that will ensure compliance, several steps should be taken: (i) 'exploration' includes open questions, and allows admission of non-compliance, e.g. in terms of failure to take drugs, or smoking; (ii) 'education' means explaining pathomechanisms, and reducing corticophobia; (iii) 'tailoring' is reached by focussing therapeutic options on individual requirements, and simplifying treatment regimens; (iv) 'contracting' involves negotiating a realistic therapeutic regimen on an individual basis; (v) 'reminders' are practical tips, which may help to overcome reluctance, e.g. by placing drugs in the toothbrush glass, and on the breakfast table, or in the sports bag; (vi) 'follow-up' ensures long-term compliance, with regular visits to the physician, and self-management programmes. In conclusion, non-compliance of patients and parents is a challenging problem in daily practice. Including the aspects of the abovementioned factors can help build up a relation of trust and partnership, which is the prerequisite of any therapeutic success. However, this is an ongoing process, which has to be continuously reviewed.
Niggemann
B
B
Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité of Humboldt University, Berlin, Germany.
D002648:Child; D002908:Chronic Disease; D006801:Humans; D010290:Parents; D010349:Patient Compliance; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D012130:Respiratory Hypersensitivity / Q000188:drug therapy*; D012648:Self Care