Bastakoti Suresh, Khanal Saval, Dahal Bibek, Pun Nirmala Tilija
Hospital and Clinical Pharmacist, Department of Pharmacy Birendra Military Hospital , Chhauni, Kathmandu, Nepal .
J Clin Diagn Res. 2013 Apr;7(4):754-7. doi: 10.7860/JCDR/2013/4872.2905. Epub 2013 Apr 1.
Nepal is one of the developing countries having many limitations in providing the quality health services to its population. In many countries, improvement in patients' adherence to the pharmacotherapy had been one of major outcome of quality pharmaceutical services. Till date, very less thing has been done in this area in Nepal; so it seems mandatory to improve the patient adherence to the treatment plans. Adherence to the medical therapy can be explained by the extent of the behavioral coincidence to the medication and non-medication regimen by a patient whereas compliance and concordance are two different models of patient adherence to the therapy. Compliance model suggests that patients have been brought responsible for being unable to follow 'doctor's order and concordance tempts to measure the degree of agreement between patient and his or her clinician about the nature of illness and the best possible therapy for the welfare of the patient. Non-adherence to the therapy may lead to different problems as consequences of non-adherence in four different level- individual, institutional, societal and national levels. Although some programs like, "Direct Observation Treatment, Short-course (DOTS) for tuberculosis, implementation of antiretroviral treatment schedules for HIV patients and pediatric vaccination models," are the examples of attention towards the cases of noncompliance in Nepal. It has long been faced its limitations in the forms of either untrained manpower or lack of good documentation of patients' adherence to therapy or high illiteracy rate or unaffordibility of patients to their treatment or lack of pharmaceutical care services.
尼泊尔是一个发展中国家，在为其民众提供高质量医疗服务方面存在诸多限制。在许多国家，提高患者对药物治疗的依从性一直是优质药学服务的主要成果之一。迄今为止，尼泊尔在这一领域所做甚少；因此，提高患者对治疗方案的依从性似乎势在必行。对药物治疗的依从性可以用患者在服药和非服药方案方面的行为符合程度来解释，而依从性和一致性是患者对治疗依从性的两种不同模式。依从性模式认为患者应对无法遵循“医嘱”负责，而一致性则试图衡量患者与其临床医生在疾病性质和患者福祉的最佳治疗方案上的一致程度。不遵守治疗可能会在个人、机构、社会和国家四个不同层面导致不同问题。尽管尼泊尔有一些项目，如“结核病直接观察短程治疗（DOTS）、为艾滋病毒患者实施抗逆转录病毒治疗方案以及儿童疫苗接种模式”，这些都是关注不依从情况的例子。长期以来，尼泊尔一直面临着各种限制，比如人力未经培训、患者治疗依从性缺乏良好记录、文盲率高、患者负担不起治疗费用或缺乏药学服务。
