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  È¯ÀÚÀÇ ¾à º¹¿ë Áؼö, ³² Å¿À̳ª ÇÏ´Â ÀϺΠÁ¤½Å°ú ÀÇ»ç
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ȯÀÚÀÇ ¾à º¹¿ë Áؼö, ³² Å¿À̳ª ÇÏ´Â ÀϺΠÁ¤½Å°ú ÀÇ»ç

¾Æ·¡ ¡°Á¤½ÅºÐ¿­Áõ ȯÀÚÀÇ µµ½Ã¶ô¡±(ÂüÁ¶ 1)Àº 2002³â 10¿ù ÃÖ¿µ Á¤½Å°ú Àü¹®ÀÇ
(´ç½Ã Àü³²´ë ÀÇ´ë Á¤½Å°ú ±³¼ö)°¡ ÀÚ½ÅÀÇ È¨ÆäÀÌÁö¿¡ °Ô½ÃÇÑ ±ÛÀÔ´Ï´Ù. ÃÖ¿µ Àü
¹®ÀÇ´Â ÀÌ ±ÛÀ» ¡°°Ç°­°ú °úÇС±¿¡µµ °Ô½ÃÇÏ¿´°í ÃÖ±Ù¿¡´Â ÀÌÀºÁÖ¶ó´Â ¹è¿ìÀÇ ÀÚ
»ì »ç°Ç°ú °ü·ÃÇÏ¿© ÀÎÅÍ³Ý ½Å¹®ÀÇ °Ô½ÃÆÇ¿¡µµ ¿Ã¶ó ÀÖ´Â °ÍÀ» ¹ß°ßÇß½À´Ï´Ù.   

1. ¿ì¸® Àǻ簡 Å«ÀÏÀÌ´Ù

ÀÌ ±ÛÀÇ ³»¿ëÀº °£´ÜÇÕ´Ï´Ù. ȯÀÚ°¡ ¾à º¹¿ëÀ» ÁؼöÇÏÁö ¾Ê¾Æ Àç¹ßÇß´Ù, ±× ÀÌÀ¯
Áß¿¡´Â ¾àÀ» ²÷°í ÇÑÀÇ¿øÀ» ãÀº °Íµµ ÀÖ°í, ȯÀÚ¿Í °¡Á·ÀÌ ¾î°¼­ ÀÌ Áö°æÀ¸·Î
¸¸µé¾ú´ÂÁö ºÐ³ë¸¦ ´À³¤´Ù´Â °ÍÀÔ´Ï´Ù. ±¸Ã¼ÀûÀ¸·Î ºÐ³ëÀÇ ´ë»ó¿¡ ´ëÇØ ÀÌ·¸°Ô
Ç¥ÇöÇß½À´Ï´Ù.

*±×·¸°Ô ¾à¹°Ä¡·áÀÇ Á߿伺À» °­Á¶ÇßÀ½¿¡µµ ¾à¹°À» Áß´ÜÇÑ P¿Í ±× °¡Á·À» ÇâÇÑ
°ÍÀ̾úÀ»±î?
*±Ùº»ÀûÀ¸·Î Ä¡·áÇØÁØ´Ù¸ç ¼ººÐ ¹Ì»óÀÇ ºñ½Ñ ÇѾàÀ» º¹¿ë½ÃÅ°°í Á¤½Å°ú ¾à¹°À»
²÷°Ô ¸¸µç... ÇÑÀǻ翡 ´ëÇÑ °ÍÀ̾úÀ»±î?
*ÀÌ·± Ȥ¼¼¹«¹ÎÀÌ ³­¹«ÇÏ´Â ÀÌ »çȸ¿¡ ´ëÇÑ °ÍÀ̾úÀ»±î?
*ÀÌ·± ºñ°úÇÐÀûÀÌ°í ºÒÇÕ¸®ÇÑ ¼¼»ó»ç¿¡ ¹«·ÂÇϱâ ¦ÀÌ ¾ø´Â ÇÊÀÚ Àڽſ¡ ´ëÇÑ
°ÍÀ̾úÀ»±î?

2002³â óÀ½ ÀÌ ±ÛÀ» º¸¾ÒÀ» ¶§ °­¹Ú»ç´Â ´Ù´Â ¾Æ´Ò °ÍÀÌÁö¸¸ ¿ì¸® Àǻ簡 Å«ÀÏ
À̶ó´Â »ý°¢À» Çß½À´Ï´Ù. ¿ì¸® ±¹¹Î°ú ȯÀÚ°¡ ³²ÀÇ Å¿, ¼¼»ó»ç Å¿ ±×¸®°í ÀÚ±«°¨
»ÓÀÎ Àǻ翡°Ô ÀǷḦ ¸Ã±â°í ÀÖ´Ù´Â °ÍÀÌ ºÒÇàÀ̶ó°í »ý°¢Çß½À´Ï´Ù.

2. ȯÀÚÀÇ ¾à º¹¿ë Áؼö¿¡ ´ëÇØ 

´ç½Ã °­¹Ú»ç´Â ÃÖ¿µ Àü¹®ÀÇÀÇ ±Û¿¡ ´ëÇÑ ºÐ¼®À» °Ô½ÃÇÏ·Á°í ¸î °¡Áö ¾à º¹¿ë ÁØ
¼ö¿¡ ´ëÇÑ ÀڷḦ ã¾Æ ³õ°í´Â ³öµÎ¾ú´Âµ¥, ȯÀÚÀÇ ¾à º¹¿ë Áؼö ¹®Á¦´Â ÀÇ»çÀÇ
Áø´Ü¿Í ó¹æ ¿À·ù¸¸Å­À̳ª ½É°¢ÇÑ ÀÇ·áÀÇ ¹®Á¦¶ó´Â °ÍÀº ´©±¸³ª ¾Ë°í ÀÖ´Â °ÍÀÔ
´Ï´Ù. ȯÀÚ°¡ ÇѾàÀ» ¸Ô¾ú´Ù´À´Ï, ÀÌÀºÁÖ¶ó´Â ¹è¿ì°¡ ÇÑÀÇ¿øÀ» ã¾Ò´Ù´Â °Í, ±×·±
°ÍÀº ¾à º¹¿ë ÁؼöÀÇ Áö¿±ÀûÀÎ ¹®Á¦ÀÔ´Ï´Ù.

°£´ÜÈ÷ ¾Æ·¡ ÂüÁ¶ 2·Î ÷ºÎÇÑ 2005³â 2¿ù 23ÀÏ ¹Ìµð¾î´ÙÀ½ÀÇ À±ÁØÈ£ÀÇ ±ÛÀ» ÀÐ
¾îº¸½Ã±â ¹Ù¶ø´Ï´Ù. ÀÌÀºÁÖÀÇ ÀÚ»ì»ç°Ç°ú °ü·ÃÇÏ¿© ÀÇ»çÀÇ ÇÑÀÇ»ç ºñÆÇÀ» ¿°µÎ¿¡
µÎ°í ¿Ã¸° ±Û °°Àºµ¥ ´À³¦ÀÌ ±×·¸´Ù´Â ¸»ÀÔ´Ï´Ù. ó¹æ¾àÀ» Á¦´ë·Î ¸ÔÁö ¾Ê¾Æ »ç
¸ÁÇϴ ȯÀÚ°¡ ¹Ì±¹¿¡¸¸ ¿¬°£ 12¸¸ 5000¸í¿¡ À̸£°í ÀÌ·Î ÀÎÇÑ °æÁ¦Àû ¼Õ½Çµµ
¿¬°£ 1000¾ï ´Þ·¯¿¡ À̸£´Â °ÍÀ¸·Î ³ªÅ¸³µ´Ù´Â ³»¿ëÀÔ´Ï´Ù. ÀÌ·± ³»¿ëµµ ÀÖ½À´Ï
´Ù. 

¡°¾àÀ» ó¹æ ¹ÞÀº ¸¸¼º ÁúȯÀÚ Áß Àý¹Ý °¡±îÀÌ°¡ Á¦´ë·Î ¾àÀ» ¸ÔÁö ¾Ê¾Ò´Ù. ¸¸¼º
ÁúȯÀÚÁß 14~21%´Â ¾Æ¿¹ ÀüÇô ¾àÀ» ¸ÔÁö ¾Ê´Â °ÍÀ¸·Î ³ªÅ¸³µ´Ù. ÁÖ¿ä Áúȯ º°
·Î »ìÆ캸¸é °íÇ÷¾Ð ȯÀÚÀÇ °æ¿ì ¾à 40%°¡ ó¹æÀ» ÁöÅ°Áö ¾Ê¾Ò°í, ´ç´¢º´ ȯÀÚ
µé ¿ª½Ã 40~50%°¡ ¾àÀ» Á¦´ë·Î ¸ÔÁö ¾Ê¾Ò´Ù.¡±
 
¾Æ·¡ ÂüÁ¶ 3(Irish Medical Journal, Sep/Oct 1999)¿¡ ÀÇÇÏ¸é ¾à º¹¿ë Áؼö´Â
À°Ã¼Àû º´ÀÎ °æ¿ì´Â 76% (60-92%)ÀÌÁö¸¸ Á¤½Å°ú º´ÀÎ °æ¿ì À̺¸´Ù ³·Àº 65%
(40-90%)¶ó°í Çß½À´Ï´Ù. ´Ù¸¥ ÀÚ·á¿¡´Â Á¤½Å°ú º´ÀÎ °æ¿ì Áؼö À²Àº 50% Á¤µµ
À̸ç ÀÌ Áß¿¡ Á¤½ÅºÐ¿­ÁõÀº 25-40%¶ó°í µÅ ÀÖ½À´Ï´Ù.

3. ÀÇ»ç´Â ³² Å¿À» ÇÏÁö ¸»¾Æ¾ß 

´Ù½Ã ¸»Çؼ­ Á¤½ÅºÐ¿­Áõ ȯÀÚÀÇ °æ¿ì 10¸í¿¡¼­ 6-7¸íÀº ¾à º¹¿ëÀ» Á¦´ë·Î Áؼö
ÇÏÁö ¾Ê´Â´Ù´Â °ÍÀÔ´Ï´Ù. À̶§ ¾à º¹¿ëÀ» ÁؼöÇÏÁö ¾Ê¾Ò´Ù°í ȯÀÚ¸¦ ºñ³­ÇÑµé ¾î
¶² Àǹ̰¡ ÀÖ°Ú½À´Ï±î? ÀÇ»çÀÇ Ãø¸é¿¡¼­ ±× ȯÀÚ¸¦ À§ÇØ ¾î¶² ³ë·ÂÀ» Çß´ÂÁö, 
ȯÀڷμ­ ¾à º¹¿ëÀ» ÀÌÇØÇÏ°í µû¸£±â ¾î·Á¿î ¾î¶² ¹®Á¦°¡ ÀÖ¾ú´ÂÁö¸¦ ÆľÇÇÏ¿©
°³¼±ÇÏ´Â °ÍÀÌ Áß¿äÇÏÁö ¾ÊÀ»±î¿ä?

Àǻ絵 ±×·¸°ÚÁö¸¸, ȯÀÚÀÇ ¾à º¹¿ë Áؼö¿¡ ¾à»çÀÇ ¿ªÇÒÀº ¾à»çµéµµ ¹è¿ì´Â °Í
ÀÔ´Ï´Ù. ÂüÁ¶ 2¿¡´Â ¡°Á¶»ç°á°ú ¸¹Àº ȯÀÚµéÀÌ Á¦´ë·Î ¾àÀ» ì°Ü ¸ÔÁö ¸øÇÏ´Â
°¡Àå Å« ÀÌÀ¯´Â ¡®¹Ù»Û Çö´ë »ýÈ°¿¡ ÂѰܼ­¡¯ ¿´´Ù¡±°í ÇÕ´Ï´Ù. ÀϹÝÀûÀÎ »óȲ
ÀÔ´Ï´Ù. À̶§ ¾àÀ» ÀØÁö ¾Ê°í º¹¿ëÇÒ ¼ö ÀÖµµ·Ï ÀÏÁ¤ÇÑ Àå¼Ò¿¡ Á¤µ·µÈ »óÅ·Î
µÐ´ÙµçÁö, ½ÉÁö¾î ¾à º¹¿ë ½Ã°£À» ¾Ë·ÁÁÖ´Â ÀÛÀº °æº¸ ½Ã½ºÅÛµµ »ý°¢ÇÒ ¼ö ÀÖ½À
´Ï´Ù. ȯÀÚÀÇ »ýÈ°¿¡ ¸ÂÃß¾î ÀûÀýÇÑ Á¦ÇüÀÇ ¾àÀ¸·Î º¹¿ë Ƚ¼ö¸¦ Á¶ÀýÇÒ ¼öµµ ÀÖ
À» °ÍÀÔ´Ï´Ù.
   
ȯÀÚ°¡ ¾àÀ» Á¦´ë·Î º¹¿ëÇÏÁö ¾Ê´Â ÀÌÀ¯ Áß¿¡´Â ¾àÀÇ ±â´ë È¿°ú¸¦ ¼÷ÁöÇÏÁö ¸ø
Çϰųª ¾àÀÇ ºÎÀÛ¿ë ¹®Á¦µµ ÀÖÀ» °ÍÀÔ´Ï´Ù. ȯÀÚ¿¡°Ô ¾à È¿°ú¸¦ ¸ð´ÏÅ͸µÇÏ´Â
¹æ¹ý°ú °¡´ÉÇÑ ºÎÀÛ¿ë°ú ´ëó ¹æ¾ÈÀ» ¾Ë·ÁÁÙ ÇÊ¿äµµ ÀÖ½À´Ï´Ù. ±×¸®°í ȯÀÚÀÇ
ºÎÀÛ¿ëÀ» È®ÀÎÇÏ¿© ¾àÀÇ º¹¿ëÀ» Á¶ÀýÇÑ´ÙµçÁö ¾àÀ» ¹Ù²Û´ÙµçÁö ÇÏ´Â ³ë·Âµµ ÇÊ
¿äÇÕ´Ï´Ù. 

Á¦ÀÏ Áß¿äÇÑ °ÍÀº ÀÇ»çÀÇ È¯ÀÚ ¸é´ãÀÔ´Ï´Ù. ȯÀÚÀÇ ¼öÁØ°ú °¨Á¤¿¡ ¸ÂÃß¾î ÀÌÇØÇÒ
¼ö ÀÖµµ·Ï ¾à º¹¿ë ÁؼöÀÇ Çʿ伺À» ¼³¸íÇØ ÁÖ¾î¾ß ÇÕ´Ï´Ù. ¾ó¸¶³ª ȯÀÚÀÇ ¸»¿¡
±Í¸¦ ±â¿ïÀÌ´ÂÁöµµ Áß¿äÇÕ´Ï´Ù. ¹°·Ð ȯÀÚ¸¦ µµ¿ÍÁÙ °¡Á·À̳ª Ä£±¸¿¡°Ôµµ ȯÀÚ¿¡
°Ô¿Í ¸¶Âù°¡Áö ¼³¸íÀÌ ÇÊ¿äÇÕ´Ï´Ù. ¹°·Ð ÀÇ»ç´Â ȯÀÚ¿Í °¡Á·°ú ÀÚÁÖ ¸é´ãÇÒ ÇÊ¿ä
°¡ ÀÖ½À´Ï´Ù. ±×¸®°í ȯÀÚ°¡ ¾à º¹¿ëÀ» ÁؼöÇÏ°í ÀÖ´ÂÁö ¸ð´ÏÅ͸µÀÌ ÇÊ¿äÇÕ´Ï´Ù.
ȯÀÚ¸¦ À§ÇÑ Àû±ØÀûÀÎ ÀÇ»çÀÇ ¿ªÇÒÀ» ¸»ÇÏ´Â °ÍÀÔ´Ï´Ù.

4. Á¤¸®Çϸé...

¿©±â¿¡ µ¡ºÙ¿© ÀÇ·á±â°üÀÇ °æ¿ì ȯÀÚ¿Í °¡Á·À» À§ÇÑ ±³À° ÇÁ·Î±×·¥µµ Áß¿äÇÏÁö
¸¸, »ó½ÄÀûÀ¸·Î º¸ÀÌ´Â ÀÌ·¯ÇÑ °ÍµéÀÌ ½ÇÁ¦ÀûÀ¸·Î Áß¿äÇÑ °ÍÀÔ´Ï´Ù. ½ÇÁ¦ ¾î¶»°Ô
ÇàÇÏ´ÂÁö°¡ Áß¿äÇÕ´Ï´Ù. ÀÇ»çÀÇ Ä¡·á ¼º°øÀÌ ¿©±â¿¡ ´Þ·È´Ù°í Çصµ °ú¾ðÀÌ ¾Æ´Õ
´Ï´Ù. ´Ù½Ã ¸»Çؼ­ Á¤½ÅºÐ¿­Áõ ȯÀÚÀÇ µµ½Ã¶ô ½ÄÀÌ ¾Æ´Ï¶ó, ºÒÈ®½ÇÇÑ ÇÑÀÇ»çÀÇ
¿µÇâ Å¿ÀÌ ¾Æ´Ï¶ó, ¹«±â·ÂÀÇ È£¼Ò°¡ ¾Æ´Ï¶ó ÀÇ»ç´Â ÀÚ½ÅÀÌ ÃÖ¼±À» ´ÙÇß´ÂÁö ¹Ý¼º
ÇÏ°í °øºÎÇÏ°í ½º½º·Î¸¦ Çâ»ó½ÃÅ°·Á´Â ³ë·ÂÀ» ÇØ¾ß ÇÕ´Ï´Ù. 
 
À¯»çÇÑ ¹®Á¦·Î, °­¹Ú»ç´Â ÀǾàºÐ¾÷°ú °ü·ÃÇÑ ´ÙÅù¿¡¼­ Àǻ簡 ¾à»çÀÇ Á÷´É±îÁö
ÆïÈÑÇÏ¸ç ¾àÀÇ Ã³¹æ°ú Á¶Á¦¸¦ ÀڽŵéÀÌ ¸Ã´Â °ÍÀÌ ÃÖ¼±À̶ó´Â ÀÌ»óÇÑ ³í¸®¸¦ ¹ß
°ßÇÏ°í ³î¶ú½À´Ï´Ù. ±× ÀÌÀü¿¡ ÀÇ»ç´Â ÀÚ½ÅÀÇ Á÷´ÉÀÇ ¹®Á¦, ¿¹¸¦ µé¾î Áø´Ü°ú ó
¹æ ¿À·ùÀÇ ½É°¢¼ºÀ» ±ú´Þ¾Æ¾ß ÇÑ´Ù°í °³ÀÎÀûÀ¸·Î ¿äµµ °á¼®ÀÇ ¿ÀÁø ¶§¹®¿¡ °ÞÀº
°íÅëµµ ¼Ò°³Çß½À´Ï´Ù. ¿ì¸® ÀÇ»ç´Â ÁøÁ¤À¸·Î ȯÀÚ¿Í °¡Á·ÀÇ °íÅëÀ» ÀÌÇØÇÏ°í ÀÖ
´Â °ÍÀϱî¿ä? 

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*ÂüÁ¶ 1

ychoi  (2002-10-11 11:05:46)
Á¤½ÅºÐ¿­º´ ȯÀÚÀÇ µµ½Ã¶ô [ÃÖ¿µ]

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Irish Medical Journal
Sep/Oct 1999 Volume 92 No 6

Editorial 
Treatment Compliance in the Mental Health Service
Author : Farragher BM

Compliance refers to the willingness and ability of the individual to follow
health-related advice, to take medication as prescribed, to attend
scheduled appointments and to complete recommended investigations. In
the United States, non-compliance with medication has been described as
'America's other drug problem'. Psychiatric patients have consistently
been proven to show a greater degree of non-compliance compared to
those with physical disorders.1 Compliance studies for physical disorders
have recorded a rate of 76% compliance ranging from 60-92%. For
psychiatric disorders the compliance rate is 65% ranging from 40-90%.
Care in the community involves an increasing number of patients with
chronic mental illness whose compliance with treatment cannot be
guaranteed. The manifestations of non-compliance may be relapse and
rehospitalisation or at worst, acts of deliberate self-harm, serious social
problems or even criminal crises.2 The effects are not only on the
mental health service but also on the family and on the wider
community.3 In outpatient clinics and day treatment centres,
non-attendance greatly compromises the efficient use of staff and effects
the quality and promptness of care. Non-compliance with medications
dispensed is an escalating cost due to the increased prices of the newer
medications. The effects of non-compliance also carry the major direct
cost factor such as increase in day or in-patient treatment along with the
indirect cost factor of patient or carer absenteeism from work.

Type and detection of noncompliance

Non-compliance with clinic appointments can take the form of missed
initial appointments, referral failures from the emergency services,
non-compliance with aftercare or treatment dropouts. Non-compliance
with drug treatment can be categorised into 5 types ¡© errors of omission,
taking medication for the wrong reasons, errors in dosage, mistakes in
timing and taking additional medication not prescribed by the physician.4

Non-compliance with medication may be difficult to detect compared to
noting non-attendance at an outpatient clinic or a treatment facility.
Indirect methods of monitoring this such as asking patients or their
relatives may be unreliable.5 Pill counts have been shown to increase
compliance, though patients may dispose of their medication rather than
taking it.6 Outcomes of therapy may be reliable for certain forms of
medication such as anticonvulsants. For many types of treatment this
approach is not sufficiently sensitive, because even if patients comply,
this does not ensure a satisfactory outcome.7 The presence of
side-effects is also a limited way of showing compliance as patients are
often unreliable in reporting side-effects. This has been shown by the
occurrence of side effects when patients are taking placebo in
double-blind control trials.

Direct methods such as blood level monitoring or measurement in urinary
excretion may be more reliable but are inconvenient and can be
expensive. Some patients may object to giving blood specimens, regarding
them as unnecessary and intrusive. Moreover, the actual problem of
carrying out specimen checks may well give a false indication of the
level of compliance by increasing it. When direct methods have been
done the degree of non-compliance has always exceeded that expected.8

Factors associated with noncompliance

Patient characteristics

The search for the prototypical non-compliant patient has proved
inconclusive. In general, the non-compliant patient is more likely to be
younger,9 of lower socioeconomic status10 and have a lower level of
education than the compliant patient.11 In the mental health service, other
factors such as patients suffering from schizophrenia12 and particularly
those with a dual diagnosis of schizophrenia and substance abuse13
require special attention from the community mental health service from a
compliance perspective.

Treatment factors

Compliance is influenced by how acceptable a patient finds the
treatment14 and also by the attitudes to health matters held by the
patient15 and others with whom he comes into contact.16 Long waiting
periods between first contact and initial appointment is associated with
non-compliance.17 Referral failures from an emergency services are
associated with having the patient organise the referral to the outpatient
department.18 Non-compliance with aftercare and treatment dropouts may
be associated with the lack of continuity and liaison between the hospital
and the outpatient teams.19 It has been found that patients who had
insight into their illness, who perceived the benefits of their medication
and also who perceived a relationship between the two are more likely to
take their medication.14

Patients are less likely to comply with complex regimens.20 Multiple
medications and frequent dosage regimens have been shown to be
associated with poor compliance. In-patients are more compliant than
outpatients.21 Parenteral administration is also associated with greater
compliance.22 It was subsequently found that non-compliance was
reduced through depot injection and furthermore when given at a clinic
supervised by a trained nurse. With regard to the severity of the illness,
patients are less likely to comply once they start to get better.8

Doctor patient relationship

Regular contact with their doctor improves compliance. An active and
interested attitude by emergency room staff is essential for the
successful completion of referrals. Clinician continuity is important as a
good relationship further improves compliance. Some studies have shown
that a good therapeutic alliance with a doctor who is enthusiastic about
treatment and its outcome, will ensure better compliance.23

How can compliance be improved?

It is important not to make prejudicial predictions of non-compliance
based on patient characteristics or using non-compliance as an excuse to
blame the patient for an unfavourable outcome. From a systemic point of
view non-compliance can be seen not only as the patients inability to
follow treatment recommendations but also as the health system's failure
to provide adequate care and to meet patients' needs. It is a major health
issue with outcomes related to levels of morbidity, mortality and
cost-utilisation.

Attendance at initial and subsequent clinic appointments can be improved
by shortening waiting times, telephone reminders and letter prompts.24
Education of potential patients about the nature of the treatment can
decrease initial missed appointments.25 In referrals from the emergency
service, the referring professional should make the initial contact with the
receiving agency and, if possible, obtain an appointment for the patient.19
Clinics and hospitals should have a flexible and accommodating intake
procedures to facilitate the referral process. Aftercare appointments
should be scheduled before patients are discharged and the time interval
between the discharge and first outpatient appointment be minimal.26
Treatment dropouts could be reduced by orientating the patient on initial
contact, introducing treatment early, making the goals of treatment
realistic. Financial incentives have also been used and found to increase
patient compliance with healthcare treatments.27 For certain groups of
patients such as the chronically mentally ill, treatment may need to be
delivered wherever they are, such as in their own homes or hostels.28

Educational strategies towards improving compliance are based on the
view that poor compliance is linked to insufficient information. Written
information alone appears insufficient to increase compliance in long-term
therapy though it has been shown to increase knowledge and decrease
medication errors. Reminder schedules, pharmacy generated refill
reminders and special medication containers or packaging have been
shown to significantly improve compliance, with fewer patients forgetting
to take medication or deviating from the prescribed dose.

A number of psychoeducation strategies have been suggested.29 These
aim to both motivate and educate the patient regarding his illness and
treatment. Such approaches have been found to improve compliance
during treatment and up to six months afterwards. While total compliance
cannot be guaranteed, clinicians must try to maximise the likelihood of
this outcome. For the mentally ill in the community, this requires a
coordinated effort both by the mental health team and the other agencies
and carers involved with the patient. Evidence-based practice suggests
that it must be a responsibility shared by clinicians and patients.

B. Farragher
Department of Psychiatry,
OurLady's Hospital,
Navan, Co. Meath.

References (»ý·«)
 
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