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Compliance: no simple matter

Patients sometimes have good reasons for interrupting their treatment, especially when it presents a negative benefit-harm balance.

In September pharmaceutical firms presented their "consensual" plan to gain legal approval for their "compliance support" or "patient support" programmes in France. In the controversy surrounding these programmes, the firms seem to be dictating the behaviour of the government and legislators and there has been little discussion of the relevance of the notion of treatment compliance. And yet there is very little certainty on this issue.

As the October issue of la revue Prescrire points out, numerous studies have concluded that compliance support programmes are not very effective. And that compliance with a treatment presenting a negative benefit-harm balance leads to increased mortality.

Studies show that patients are often wary of drugs, mainly because of their adverse effects, or the risk of dependence. Many patients seek to take the smallest dose possible, or try stopping treatment. They also want to ensure that taking the medication disrupts their schedule as little as possible – behaviour that is perfectly logical.

La revue Prescrire's analysis of the compliance support programmes currently being carried out in France shows that they relate to drugs with a negative benefit-harm balance, or treatments that have either not been adequately evaluated or for which there are preferable alternatives.

The priority is not to force patients to continue with treatments that are ineffective, impractical or poorly tolerated, but to develop and to utilise better treatment options.

©Prescrire 1 Octobre 2007

Source: "'Observance' des traitements : pas si simple" Rev Prescrire 2007; 27 (288): 782-783.

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