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| title | chunk | source | category | tags | date_saved | instance |
|---|---|---|---|---|---|---|
| Adherence (medicine) | 1/5 | https://en.wikipedia.org/wiki/Adherence_(medicine) | reference | science, encyclopedia | 2026-05-05T07:25:48.247796+00:00 | kb-cron |
In medicine, patient adherence describes the degree to which a person 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, therapy sessions, or medical follow-up visits. Patient compliance and patient adherence may be used interchangeably but adherence emphasizes the role of the patient in decision-making and factors that influence the ability to follow instructions. Concordance is the process by which a patient and clinician make decisions together about treatment. Differences in terminology reflect regional variation, deliberate distinctions, and the preferences of various groups and organizations. Both patient and health-care provider affect adherence, and a positive physician-patient relationship is the most important factor in improving compliance. Access to care plays a role in patient adherence, whereby greater wait times to access care contributing to greater absenteeism. The cost of prescription medication and potential side effects also play a role. 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. 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. 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. It is still unclear how adherence can consistently be improved in order to promote clinically important effects.
== Terminology == In medicine, compliance 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 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. As of 2003, US health care professionals more commonly used the term "adherence" to a regimen rather than "compliance", because it has been thought to reflect better the diverse reasons for patients not following treatment directions in part or in full. Additionally, the term adherence includes the ability of the patient to take medications as prescribed by their physician with regards to the correct drug, dose, route, timing, and frequency. It has been noted that compliance may only refer to passively following orders. The term adherence is often used to imply a collaborative approach to decision-making and treatment between a patient and clinician. The term concordance has been used in the United Kingdom to involve a patient in the treatment process to improve compliance, and refers to a 2003 NHS initiative. In this context, the patient is informed about their condition and treatment options, involved in the decision as to which course of action to take, and partially responsible for monitoring and reporting back to the team. Informed intentional non-adherence is when the patient, after understanding the risks and benefits, chooses not to take the treatment. As of 2005, the preferred terminology remained a matter of debate. As of 2007, concordance has been used to refer specifically to patient adherence to a treatment regimen which the physician sets up collaboratively with the patient, to differentiate it from adherence to a physician-only prescribed treatment regimen. Despite the ongoing debate, adherence has been the preferred term for the World Health Organization, The American Pharmacists Association, and the U.S. National Institutes of Health Adherence Research Network. The Medical Subject Headings of the United States National Library of Medicine defines various terms with the words adherence and compliance. Patient Compliance and Medication Adherence are distinguished under the MeSH tree of Treatment Adherence and Compliance.
== Adherence factors == In 2003 WHO estimated that half of those for whom long term treatment regimens are prescribed do not follow them as directed. In general, adherence is higher in diseases where people see a greater health threat, such as HIV/AIDS and cancer, and it is lower for chronic conditions such as hypertension, asthma or diabetes. Factors can be categorized on 3 levels: individual, cultural and healthcare system level.
=== Individual factors === Depressive symptoms and perceived discrimination have been correlated with poor adherence.
=== Side effects === Negative side effects of a medicine can influence adherence.
=== Socioeconomic status === Medication adherence rates are typically lower with lower socioeconomic status, increased stress related to difficult life circumstances. Poverty is associated with Low levels of literacy and numeracy. Adults in more deprived areas, such as the North East of England, performed at a lower level than those in less deprived areas such as the South East. Local authority tenants and those in poor health were particularly likely to lack basic skills.