Addictions and other obstacles to adherence to therapy: a case report

Abstract

Introduction: Non-adherence to therapy is a prevalent problem, especially among patients with multiple comorbidities. The aim of this case report is to raise awareness of the importance of the patient-centered clinical method in dealing with this issue. Case report: We present the case of a 49-year-old single female living alone with type 2 diabetes, hepatitis C infection, and a previous history of drug abuse. She had poor metabolic control even after suffering an ischemic stroke at 48 years of age, which left her with weakness of her left arm. The patient was invited by her family physician for a family assessment interview, including a review of her habits and medications and an exploration of her beliefs, fears, and expectations about her health problems and their importance to her. There was no evidence of family dysfunction but she was found to have a compulsion to eat sweets and she reported current hashish and tobacco consumption. Her poor adherence to therapy was confirmed. She was only taking three out of eight medications prescribed, due to a lack of awareness of their indications and fear of adverse effects. The patient’s ideas and fears about her treatment were explored and clarified, and therapy was optimized according to her expectations. Nursing support was obtained and contact was made with her neurologist and endocrinologist. In subsequent visits, adherence to therapy reported by the patient was improved along with partial adherence to the recommended diet, resulting in improved metabolic control. Discussion: This is a case report of a patient with multimorbidity and non-adherence to therapy. The patient benefitted from a multidisciplinary approach, a good doctor-patient relationship, and effective communication. The patient centered clinical method was helpful in achieving these goals and the family physician was well placed to apply it.