Adherence (medicine)

In medicine, patient compliance (also adherence, capacitance) describes the degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to other situations such as medical device use, self care, self-directed exercises, or therapy sessions. Both patient and health-care provider affect compliance, and a positive physician-patient relationship is the most important factor in improving compliance.^[1] Access to care plays a role in patient adherence, whereby greater wait times to access care contributing to greater absenteeism.^[2] The cost of prescription medication also plays a major role.^[3]

Compliance can be confused with concordance, which is the process by which a patient and clinician make decisions together about treatment.^[4]

Worldwide, non-compliance is a major obstacle to the effective delivery of health care. 2003 estimates from the World Health Organization indicated that only about 50% of patients with chronic diseases living in developed countries follow treatment recommendations with particularly low rates of adherence to therapies for asthma, diabetes, and hypertension.^[1] Major barriers to compliance are thought to include the complexity of modern medication regimens, poor health literacy and not understanding treatment benefits, the occurrence of undiscussed side effects, poor treatment satisfaction, cost of prescription medicine, and poor communication or lack of trust between a patient and his or her health-care provider.^[5]^[6]^[7]^[8]^[9] Efforts to improve compliance have been aimed at simplifying medication packaging, providing effective medication reminders, improving patient education, and limiting the number of medications prescribed simultaneously. Studies show a great variation in terms of characteristics and effects of interventions to improve medicine adherence.^[10] It is still unclear how adherence can consistently be improved in order to promote clinically important effects.^[10]

^ ^a ^b World Health Organization (2003). Adherence to long-term therapies: evidence for action (PDF). Geneva: World Health Organisation. ISBN 978-92-4-154599-0.
^ Baker SE, Silvernail J, Scoville C, Kushner S, Mabry L, Konitzer L, et al. (January 2020). "When Exception to Policy Is Exceptional Policy: How Booking Physical Therapy Appointments Too Far in the Future May Adversely Impact Access to Care, Business Optimization, and Readiness". Military Medicine. 185 (Suppl 1): 565–570. doi:10.1093/milmed/usz287. PMID 32074310.
^ Cite error: The named reference Harris was invoked but never defined (see the help page).
^ "Medicines concordance (involving patients in decisions about prescribed medicines)". National Institute for Health and Clinical Excellence. 3 March 2008. Archived from the original on 2007-04-27. Retrieved 2011-12-31.
^ Cite error: The named reference APA was invoked but never defined (see the help page).
^ Cite error: The named reference Ngoh was invoked but never defined (see the help page).
^ Elliott RA, Marriott JL (July 2009). "Standardised assessment of patients' capacity to manage medications: a systematic review of published instruments". BMC Geriatrics. 9: 27. doi:10.1186/1471-2318-9-27. PMC 2719637. PMID 19594913.
^ Berhe DF, Taxis K, Haaijer-Ruskamp FM, Mulugeta A, Mengistu YT, Burgerhof JG, Mol PG (September 2017). "Impact of adverse drug events and treatment satisfaction on patient adherence with antihypertensive medication - a study in ambulatory patients". British Journal of Clinical Pharmacology. 83 (9): 2107–2117. doi:10.1111/bcp.13312. PMC 5555859. PMID 28429533.
^ Bousquet, Jean; Schünemann, Holger J.; Togias, Akdis; Bachert, Claus; Erhola, Martina; Hellings, Peter W.; et al. (Allergic Rhinitis and Its Impact on Asthma Working Group) (October 15, 2019). "Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence". Journal of Allergy and Clinical Immunology. 145 (1). Elsevier BV: 70–80.e3. doi:10.1016/j.jaci.2019.06.049. hdl:10400.17/3723. ISSN 0091-6749. PMID 31627910. S2CID 204786988. Health literacy is an important component of adherence to medications,[68],[69] but given the behavior of allergists as patients, it appears that other factors are more important. Possibly, it is human nature that drives adherence to treatment irrespective of whether the patient is a physician, and behavioral science is an important need to be considered in medical care.
^ ^a ^b Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, et al. (November 2014). "Interventions for enhancing medication adherence". The Cochrane Database of Systematic Reviews. 2014 (11): CD000011. doi:10.1002/14651858.CD000011.pub4. PMC 7263418. PMID 25412402.

[WhoReport-1] World Health Organization (2003). Adherence to long-term therapies: evidence for action (PDF). Geneva: World Health Organisation. ISBN 978-92-4-154599-0.

[2] Baker SE, Silvernail J, Scoville C, Kushner S, Mabry L, Konitzer L, et al. (January 2020). "When Exception to Policy Is Exceptional Policy: How Booking Physical Therapy Appointments Too Far in the Future May Adversely Impact Access to Care, Business Optimization, and Readiness". Military Medicine. 185 (Suppl 1): 565–570. doi:10.1093/milmed/usz287. PMID 32074310.

[Harris-3] Cite error: The named reference Harris was invoked but never defined (see the help page).

[4] "Medicines concordance (involving patients in decisions about prescribed medicines)". National Institute for Health and Clinical Excellence. 3 March 2008. Archived from the original on 2007-04-27. Retrieved 2011-12-31.

[APA-5] Cite error: The named reference APA was invoked but never defined (see the help page).

[Ngoh-6] Cite error: The named reference Ngoh was invoked but never defined (see the help page).

[Elliott2009-7] Elliott RA, Marriott JL (July 2009). "Standardised assessment of patients' capacity to manage medications: a systematic review of published instruments". BMC Geriatrics. 9: 27. doi:10.1186/1471-2318-9-27. PMC 2719637. PMID 19594913.

[8] Berhe DF, Taxis K, Haaijer-Ruskamp FM, Mulugeta A, Mengistu YT, Burgerhof JG, Mol PG (September 2017). "Impact of adverse drug events and treatment satisfaction on patient adherence with antihypertensive medication - a study in ambulatory patients". British Journal of Clinical Pharmacology. 83 (9): 2107–2117. doi:10.1111/bcp.13312. PMC 5555859. PMID 28429533.

[Bousquet_Schünemann_Togias_Bachert_2020_pp._70–80.e3-9] Bousquet, Jean; Schünemann, Holger J.; Togias, Akdis; Bachert, Claus; Erhola, Martina; Hellings, Peter W.; et al. (Allergic Rhinitis and Its Impact on Asthma Working Group) (October 15, 2019). "Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence". Journal of Allergy and Clinical Immunology. 145 (1). Elsevier BV: 70–80.e3. doi:10.1016/j.jaci.2019.06.049. hdl:10400.17/3723. ISSN 0091-6749. PMID 31627910. S2CID 204786988. Health literacy is an important component of adherence to medications,[68],[69] but given the behavior of allergists as patients, it appears that other factors are more important. Possibly, it is human nature that drives adherence to treatment irrespective of whether the patient is a physician, and behavioral science is an important need to be considered in medical care.

[:2-10] Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, et al. (November 2014). "Interventions for enhancing medication adherence". The Cochrane Database of Systematic Reviews. 2014 (11): CD000011. doi:10.1002/14651858.CD000011.pub4. PMC 7263418. PMID 25412402.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]