Compliance (medicine): Difference between revisions
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'''Compliance''' (or '''Adherence''') in a medical context refers to a [[patient]] both agreeing to and then undergoing some part of their treatment program as advised by their doctor or other healthcare worker. Most commonly it is whether a patient takes their medication ('''Drug compliance'''), but may also apply to use of surgical appliances (e.g. compression stockings), [[chronic wound]] care, self-directed physiotherapy exercises, or attending for a course of therapy (e.g. counselling). | '''Compliance''' (or '''Adherence''') in a medical context refers to a [[patient]] both agreeing to and then undergoing some part of their treatment program as advised by their doctor or other healthcare worker. Most commonly it is whether a patient takes their medication ('''Drug compliance'''), but may also apply to use of surgical appliances (e.g. compression stockings), [[chronic wound]] care, self-directed physiotherapy exercises, or attending for a course of therapy (e.g. counselling). | ||
It has been estimated that in developed countries only 50% of patients who suffer from chronic diseases adhere to treatment recommendations.<ref name="WHOreport"> Sabaté, E. (ed.): "Adherence to Long term Therapies: Evidence for Action". ''[[World Health Organization]]''. Geneva, 2003. 212 pp. ISBN 92-4-154599-2. [http://www.who.int/chronic_conditions/adherencereport/en/ Report] 2003</ref> Compliance rates during closely monitored research studies are usually far higher than in later real-world situations (e.g. up to 97% compliance in some studies on [[statin]]s, but only about 50% of patients continue at six months).<ref name="BandolierStatins2004"> "Patient Compliance with statins" ''[[Bandolier (journal)|Bandolier]] [http://www.jr2.ox.ac.uk/bandolier/booth/cardiac/patcomp.html Review] 2004</ref> | |||
Nonadherence may affect the patient's own immediate health or have implications for the wider society (e.g. failure to prevent complications from chronic diseases, formation of resistant infections or untreated psychiatric illness). | |||
==Terminology== | |||
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 willful failure to observe instructions, although forgetfulness is probably a more common reason. But today, health care professionals prefer to talk about "'''adherence'''" to a regimen rather than "'''compliance'''". The word “adherence” may be preferred by many health care providers, because “compliance” suggests that the patient is passively following the doctor’s orders and that the treatment plan is not based on a therapeutic alliance or contract established between the patient and the physician. According to some, both terms are imperfect and uninformative descriptions of medication-taking behavior.<ref>L. Osterberg and T. Blaschke, <u>Adherence to Medication<u>, [[N Engl J Med]], '''2005'''(''353''):487-97.</ref> | |||
==Causes== | |||
Causes for poor compliance include:<ref name="BNF">''[[British National Formulary]]''. ''45'' March 2003.</ref> | Causes for poor compliance include:<ref name="BNF">''[[British National Formulary]]''. ''45'' March 2003.</ref> | ||
*Forgetfulness | *Forgetfulness | ||
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*Complicated regimen | *Complicated regimen | ||
*Cost of drugs | *Cost of drugs | ||
==Detection== | ==Detection== | ||
Revision as of 18:21, 19 February 2020
Compliance (or Adherence) in a medical context refers to a patient both agreeing to and then undergoing some part of their treatment program as advised by their doctor or other healthcare worker. Most commonly it is whether a patient takes their medication (Drug compliance), but may also apply to use of surgical appliances (e.g. compression stockings), chronic wound care, self-directed physiotherapy exercises, or attending for a course of therapy (e.g. counselling).
It has been estimated that in developed countries only 50% of patients who suffer from chronic diseases adhere to treatment recommendations.[1] Compliance rates during closely monitored research studies are usually far higher than in later real-world situations (e.g. up to 97% compliance in some studies on statins, but only about 50% of patients continue at six months).[2]
Nonadherence may affect the patient's own immediate health or have implications for the wider society (e.g. failure to prevent complications from chronic diseases, formation of resistant infections or untreated psychiatric illness).
Terminology
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 willful failure to observe instructions, although forgetfulness is probably a more common reason. But today, health care professionals prefer to talk about "adherence" to a regimen rather than "compliance". The word “adherence” may be preferred by many health care providers, because “compliance” suggests that the patient is passively following the doctor’s orders and that the treatment plan is not based on a therapeutic alliance or contract established between the patient and the physician. According to some, both terms are imperfect and uninformative descriptions of medication-taking behavior.[3]
Causes
Causes for poor compliance include:[4]
- Forgetfulness
- Prescription not collected or not dispensed
- Purpose of treatment not clear
- Perceived lack of effect
- Real or perceived side-effects
- Instructions for administering not clear
- Physical difficulty in complying (e.g. with opening medicine containers, handling small tablets or swallowing difficulties, travel to place of treatment)
- Unattractive formulation (e.g. unpleasant taste)
- Complicated regimen
- Cost of drugs
Detection
Non-adherence can be detected by validated questionnaires and by assessing refill records[5][6].
Assessment of refill records
When refill records are accessible, many metrics can be calculated. The two most common are[7]:
- Medication Possession Ratio (MPR): "the sum of the days’ supply for all fills of a given drug in a time period divided by the number of days in the time period"[7]
- Proportion of Days Covered (PDC) is the same as the MPR but adjusts for days with double coverage of medications due to early refills[7].
Providing refill information to health care providers can reduce clinical inertia and improve the quality of prescribing[10].
Questionnaire
Available surveys include[11]:
- MMAS-4 (4 items). Copyrights have been reported contested for the MMAS-4[12]
- Morisky Medication Adherence Scale, derived from MMAS-4 (8 items)[13]
- The Adherence Estimator (3 items)[14]
- Self-Rating Scale Item (SRSI)[11]
Interventions
Interventions to improve adherence have been reviewed[5].
Concordance
Concordance is an approach at involving the patient in the treatment process to improve compliance and is a current UK NHS initiative.[15] The patient, being informed about the condition and the various treatment options, is jointly involved in the decision as to which course of action to take and partially responsible for the monitoring and reporting back to others involved in their care. 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 concerns for long-term use
- Prescribing the minimum number of different medications, e.g. prescribing for someone with two concurrent infections a single antibiotic that addresses the sensitivities of both likely bacteria, rather than two separate courses of antibiotics. However, this also raises the spectre of developing antibiotic resistant species in the wider scenario.
- Simplifying dosage regimen, whether by selecting a different drug or using a sustained release preparations that need less frequent dosages during the day.[16]
- Explanation of possible side effects and whether important to continue with the course of medication none-the-less.
- Advice on minimising or otherwise coping with side effects, e.g. advice on whether to take a particular drug on an empty stomach or with food.
- Developing trust between the patient and their doctor such that patients do not feel they will be embarrassed or seen as ungrateful if they are unable to take a particular drug, thus allowing a better tolerated alternative preparation to be tried.
See also
References
- ↑ Sabaté, E. (ed.): "Adherence to Long term Therapies: Evidence for Action". World Health Organization. Geneva, 2003. 212 pp. ISBN 92-4-154599-2. Report 2003
- ↑ "Patient Compliance with statins" Bandolier Review 2004
- ↑ L. Osterberg and T. Blaschke, Adherence to Medication, N Engl J Med, 2005(353):487-97.
- ↑ British National Formulary. 45 March 2003.
- ↑ 5.0 5.1 Kini V, Ho PM (2018). "Interventions to Improve Medication Adherence: A Review". JAMA. 320 (23): 2461–2473. doi:10.1001/jama.2018.19271. PMID 30561486.
- ↑ Hamdidouche I, Jullien V, Boutouyrie P, Billaud E, Azizi M, Laurent S (2017). "Drug adherence in hypertension: from methodological issues to cardiovascular outcomes". J Hypertens. 35 (6): 1133–1144. doi:10.1097/HJH.0000000000001299. PMID 28306634.
- ↑ 7.0 7.1 7.2 Raebel MA, Schmittdiel J, Karter AJ, Konieczny JL, Steiner JF (2013). "Standardizing terminology and definitions of medication adherence and persistence in research employing electronic databases". Med Care. 51 (8 Suppl 3): S11–21. doi:10.1097/MLR.0b013e31829b1d2a. PMC 3727405. PMID 23774515.
- ↑ : Adherence to Antipsychotic Medications For Individuals with Schizophrenia. Available at https://qpp.cms.gov/docs/QPP_quality_measure_specifications/CQM-Measures/2019_Measure_383_MIPSCQM.pdf
- ↑ dherence to Chronic Medications. Available at http://www.qualityforum.org/QPS/0542e
- ↑ Kronish IM, Moise N, McGinn T, Quan Y, Chaplin W, Gallagher BD; et al. (2016). "An Electronic Adherence Measurement Intervention to Reduce Clinical Inertia in the Treatment of Uncontrolled Hypertension: The MATCH Cluster Randomized Clinical Trial". J Gen Intern Med. 31 (11): 1294–1300. doi:10.1007/s11606-016-3757-4. PMC 5071278. PMID 27255750.
- ↑ 11.0 11.1 Stirratt MJ, Dunbar-Jacob J, Crane HM, Simoni JM, Czajkowski S, Hilliard ME; et al. (2015). "Self-report measures of medication adherence behavior: recommendations on optimal use". Transl Behav Med. 5 (4): 470–82. doi:10.1007/s13142-015-0315-2. PMC 4656225. PMID 26622919.
- ↑ Available at https://irb.upenn.edu/sites/default/files/2018-11-06%20v2%20Notice%20to%20Investigators%20re%20MMAS.pdf
- ↑ Morisky DE, Ang A, Krousel-Wood M, Ward HJ (2008). "Predictive validity of a medication adherence measure in an outpatient setting". J Clin Hypertens (Greenwich). 10 (5): 348–54. doi:10.1111/j.1751-7176.2008.07572.x. PMC 2562622. PMID 18453793.
- ↑ McHorney CA (2009). "The Adherence Estimator: a brief, proximal screener for patient propensity to adhere to prescription medications for chronic disease". Curr Med Res Opin. 25 (1): 215–38. doi:10.1185/03007990802619425. PMID 19210154.
- ↑ "Not to be taken as directed - Putting concordance for taking medicines into practice" BMJ. 2003;326:348-349 ( 15 February ) Editorial.
- ↑ "Dosing and compliance?" Bandolier 117 Nov 2003 Report (see Figure 1)