Compliance (medicine) - Terminology

Terminology

An estimated half of those for whom treatment regimens are prescribed do not follow them as directed. Until recently, this was termed "non-compliance", which was sometimes regarded as meaning that not following the directions for treatment was due to irrational behavior or willful ignoring of instructions. Today, health care professionals more commonly use the terms "adherence" to or "concordance" with a regimen rather than "compliance", because these terms are thought to more accurately reflect the diverse reasons for patients not following treatment directions in part or in full. However, the preferred terminology remains a matter of debate. In some cases, concordance is used to refer specifically to patient adherence to a treatment regimen that is designed collaboratively by the patient and physician, to differentiate it from adherence to a physician only prescribed treatment regimen. Despite the ongoing debate, adherence is the preferred term for the World Health Organization, The American Pharmacists Association, and the U.S. National Institutes of Health Adherence Research Network.

Concordance also refers to a current UK NHS initiative to involve the patient in the treatment process to improve compliance. In this context, the patient is informed about their condition and treatment options. They are involved with the treatment team in the decision as to which course of action to take, and partially responsible for monitoring and reporting back to the team. Compliance with treatment is improved by:

• Only recommending treatments that are effective in circumstances when they are required
• Selecting treatments with lower levels of side effect or fewer concerns for long-term use
• Prescribing the minimum number of different medications, e.g., prescribing a single antibiotic that addresses two concurrent infections (though risking contributing to antibiotic resistant species development)
• Simplifying dosage regimen by selecting a different drug or using a sustained release preparation that needs fewer doses during the day
• Discussing possible side effects, and whether it is important to continue medication regardless of those effects
• Advice on minimising or coping with side effects, e.g., whether to take a particular drug on an empty stomach or with food
• Developing trust so patients don't fear embarrassment or anger if unable to take a particular drug, allowing the doctor to try a better tolerated alternative