N. P. M. Caeyers^1
1EULAR Social Leagues, ReumaNet, Mol, Belgium

Abstract: When getting diagnosed with any kind of chronic condition, life changes in many different ways. Not only do most people have to learn how to cope with pain and/or a limited level of energy and mobility, medicines become part of daily life too and often the lifestyle has to be adapted as well. These factors will always remind people of the fact that they are not healthy. Although patients are told to follow the instructions of their doctors, a lot of them do not do so. Medications are not taken, diets not strictly followed, exercises not done as they should. Often, people are not used to taking medicines on a regular basis, specially not when they are still young. Medication only works when taken as prescribed. Not doing so is not only a waste of money, but can also give adverse effects. Test results will be influenced by the way the patient deals with his condition in an overall way.
Compliance is an important subject, that needs to be taken into account during follow-up of a patient. There can be different reasons for not following advices of doctors or HP:
=> some patients simply forget what they should be doing, or forget to take their medication as prescribed
the positive effects of the treatment/ advice is not clear
=> the image of the prescribed treatment is rather negative (e.g. steroids)
=> influence from other kinds of therapies (e.g. homeopathy)
=> too many adverse effects; exercises are too difficult
=> too many rules and changes over a short period of time (e.g. stop smoking and a diet at the same time)
=> social control: patient does not want to be “different”
=> skipping treatment or exercise when a flare is under control (problem of “drugholidays”)

Compliance should be a main topic within the patient – doctor/ HP communication. Not following the instructions can worsen the patient’s condition so the reasons for treatment or adaptations in lifestyle have to be very clear and a positive attitude towards the medication and other ways of managing the condition can help a lot. Patients that are well informed tend to have a better disease course.
What can doctors and health professionals do:
=> read the information leaflets/ instructions together with the patient and explain what is not clear, so that he knows exactly what is expected of him
=> inform the patient about possible side effects
=> inform the patient on what can go wrong if he does not follow the instructions as prescribed, e.g. not following a strict diet, smoking, alcohol…
=> prescribe medicines that are easy to take (e.g. ones a day, instead of three times) and exercises that are easy to do
=> offer tools like a medication box, a patient passport, diary…
=> have compliance as a subject during consultation. Try to solve problems when they occur. Give the patient the opportunity to explain his experiences