Adherence (compliance) and concordance

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[edit] Adherence (compliance)

It has been estimated that half of those for whom medicines are prescribed do not take them in the recommended way. Until recently this was termed “non-compliance”, which was sometimes regarded as a manifestation of irrational behavior or wilful failure to observe instructions, although forgetfulness is probably a more common reason. But today, healthcare professionals prefer to talk about “adherence” to a regimen rather than “compliance”.

There are many reasons why patients do not take medicines in the ways that health professionals expect them to, for example:

  • Lack of agreement that a prescription medicine is the best treatment for an illness
  • Concern about the effectiveness of a treatment or about possible adverse effects
  • Failure to appreciate the reasons for therapy
  • Forgetfulness

There have been many studies of the effects of different strategies in improving adherence to therapy. These include reducing the frequency of administration during the day and reducing the numbers of medicines the patient has to take. However, evidence that such measures are effective is lacking.

Nevertheless, it seems likely that adherence can be improved by taking care to explain the benefits and adverse effects of a drug; in a busy clinic it is all too easy for the prescriber to issue a prescription with little or no explanation. Reducing the frequency of administration to once, or, at most, twice a day also makes sense, despite lack of convincing evidence that this is effective.

[edit] Concordance

Concordance is a term that has been coined to reflect the changing nature of the relationship between patients and prescribers.

Concordance encapsulates the notion that there should be an explicit agreement between the patient and the prescriber; an impression that agreement has been reached is not enough. It recognizes that patients should have the casting vote and may decide not to take a medicine, even when it appears to be in their best interests. The corollary of this is that patients should take greater responsibility for their treatment and the consequences of their actions.

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