Talk:Adherence (medicine)

This article was the subject of a Wiki Education Foundation-supported course assignment, between 11 January 2022 and 13 April 2022. Further details are available on the course page. Student editor(s): Enlawal, Biomedstudent156 (article contribs).

Merge

The proposed merging is a very good idea Alanmcleod 18:02, 12 March 2007 (UTC)

terminology: adherence vs. compliance

'Adherence' is the more useful term in describing the degree to which a patient follows a prescribed health regimen.

'Compliance' should not be used to describe the degree to which a patient adheres to a prescribed regimen because the term 'compliance':

1. denotes a power relationship between the prescriber and patient ( i.e. and implies that the patient is subordinate to the authoritarian prescriber and must submit to an unpleasant prescription )

2. implies that the patient is being commanded and challenged to obey in the same way that a law commands and challenges a citizen to obey (and thus, when a patient is 'non-compliant' one is essentially saying the patient is a 'scofflaw').

An intelligent patient will typically feel resentment and mistrust toward a practitioner who harbors this cynical "compliance/non-compliance" attitude.

'Adherence' appropriately describes the actions of patient towards the prescribed regimen without conferring an authoritarian position to the prescriber ( physician ). The term 'adherence' removes the connotation of law enforcement and submission. The term 'adherence' opens a constructive line of inquiry when a health care regimen is not followed. The term 'adherence' invites the patient and physician to engage successfully in a collaborative process to prevent illness or restore health. Constantinos Voulgaropoulos 02:18, 11 September 2007 (UTC)

Compliance is a term still widely used by health care professionals in the UK, it has been noted that the term may seem derogatory but as the ethos was shifting to using a concordance approach instead the term has remained. --Nate1481( ^t/_c) 09:05, 11 September 2007 (UTC)

Still case that in UK dosctors talk, of compliance by patients, and concordance as the approach taken to engage patients in the process of deciding about treatment. Adherence is not a term I encounter. David Ruben ^Talk 23:53, 16 April 2010 (UTC)

All three terms (compliance, adherence, concordance) are used interchangeably, however there is a noticeable trend toward replacing 'compliance' with 'adherence' and using 'concordance' to refer to specific situations where patients participate in the choice of treatment regimen. The purpose of Wikipedia is to be a general reference for the public worldwide, and so I think it is best to include all three terms and note they all refer to the same issue: the degree to which patients followed a prescribed treatment regimen. It is also reasonable to include a discussion of the terminology debate to explain why there are three terms in common use for this process. I've added a section like this for consideration.

related references (see also, Terminology section in main article):

• Tilson HH. Adherence or compliance? Changes in terminology. Ann Pharmacother. (2004);38(1):161-2. PMID 14742813
• Ngoh LN. Health literacy: A barrier to pharmacist–patient communication and medication adherence. J Am Pharm Assoc. (2009);49:e132–e149. PMID 19748861

BSW-RMH (talk) 16:43, 12 May 2010 (UTC)

I would support a rename of this article to Adherence and have the other terms redirect here. I see the word "adherence" used in the majority of literature. Blue Rasberry (talk) 03:51, 24 October 2011 (UTC)

As usual, we look for wp:MEDRS to support our choices. The best I've found so far are:

• De las Cuevas C (2011 May). "Towards a clarification of terminology in medicine taking behavior: compliance, adherence and concordance are related although different terms with different uses". Curr Clin Pharmacol. 6 (2): 74–7. doi:10.2174/157488411796151110. PMID 21592067. {{cite journal}}: Check date values in: |date= (help)
• Cabrera-Abreu C (2011 May). "It is now personal: recent views on the assessment of therapeutic infidelity in severe mental illness". Curr Clin Pharmacol. 6 (2): 78–82. doi:10.2174/157488411796151138. PMID 21592068. {{cite journal}}: Check date values in: |date= (help)
• Horne R, Weinman J, Barber N, Elliott R, Morgan M, Cribb A, Kellar I (December 2005). "Concordance, adherence and compliance in medicine taking: Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO)" (PDF). Retrieved 24 Oct 2011.{{cite web}}: CS1 maint: multiple names: authors list (link)

While I have not seen the full text of the former two papers, it is clear that there has been a recent terminological shift from "compliance" towards "adherence" in describing patient behaviour in taking medication, while also acknowledging that the terms have somewhat different meanings. It would seem appropriate to for our article to discuss the distinction and the shift in usage. I don't think it matters much which title the article carries, so long as the necessary redirects are in place. LeadSongDog come howl! 15:51, 24 October 2011 (UTC)

Commonly, psychologists and psychiatrists understand the two terms in the following way: "Adherence is an active choice of patients to follow through with the prescribed treatment while taking responsibility for their own well-being. Compliance is a passive behavior in which a patient is following a list of instructions from the doctor." Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419016/ — Preceding unsigned comment added by 2003:DF:9721:9334:7430:8A34:BD3D:7554 (talk) 14:38, 4 March 2022 (UTC)

External Review Comments

The following comments are from an external reviewer BSW-RMH as part of the new joint Wikipedia:WikiProject Medicine/Google Project.

Hello Compliance (medicine) article writers and editors, This article had only one major debate on this talk page, for which I have provided a suggested resolution-that is adding a section on Terminology to the article. The rest of this review will primarily focus on fact checking and adding relevant references to address the citation needed tags throughout the article. In addition, I hope that I can offer some useful suggestions to enhance it further. Specific suggestions are as follows:

Societal impact

I've added this section, but it needs to be expanded to discuss the impact of non-compliance on the public health, healthcare costs, and patient's clinical outcome. Useful resources for this information include:

See economic statistics presented in this article with associated primary references:

• http://www.medscape.com/viewarticle/720999

"Poor adherence is the primary reason for suboptimal clinical benefit. It causes medical and psychosocial complications of disease, reduces patients’ quality of life, and wastes health care resources.Taken together, these direct consequences impair the ability of health care systems around the world to achieve population health goals."

• WHO Adherence to long-term therapies: evidence for action. (2003) ISBN 92 4 154599 2 [1]

Example facts that can be incorporated taken verbatim from the APA Highlight Newsletter: "Approximately 125,000 deaths annually are attributed to nonadherence, or twice the number killed each year in automobile accidents. Up to 11% of hospital admissions and 40% of nursing home admissions are due to lack of adherence with medication therapy. The direct and indirect costs of nonadherence total approximately $100 billion per year in the United States."

• APA Highlights Newsletter, Oct 2004, V.7(4) [2]

BSW-RMH (talk) 18:36, 12 May 2010 (UTC)

Compliance issues

• Updated statistics and citations added for prescription fill rates. BSW-RMH (talk) 00:28, 13 May 2010 (UTC)
• Updated statistics and citations added for course completion. The list of example compliance rates and consequences could be expanded to further improve this section. BSW-RMH (talk) 01:26, 13 May 2010 (UTC)

Thanks for your work on this, and I apologize that it's fallen on deaf ears so far. I will work on implementing your excellent suggestions in the next week or so, and thanks again. :) MastCell ^Talk 04:15, 23 May 2010 (UTC)

Thanks! We were asked this week if the articles we reviewed have been updated and are ready for translation to other languages. I'll make a note that someone is actively working on this one. BSW-RMH (talk) 15:16, 26 May 2010 (UTC)

Concordance

As the lead states, "Compliance is commonly confused with concordance..." Would it be appropriate for Concordance (medicine) to have its own page? 86.181.64.67 (talk) 13:22, 4 June 2014 (UTC)

Models of Compliance

How much should the article discuss the attempts at understanding Compliance. There are a number of theoretical/frameworks in the literature that work to model/understand/predict beyond the demographic risk factors for Non-Adherence already covered in 'Compliance issues':

• Health Belief Model
• The Necessity-Concerns Framework
• the SIMPLE list of techniques
• Physician-Patient Concordance

There's also much on Multivariate modeling of clinic no-show behavior; Does that fall under Compliance? Timetraveler3.14 (talk) 21:45, 21 December 2014 (UTC)

Ironically, Language Concordance, Cultural Concordance, Racial/Ethnic Concordance

Some current patient-centered research discussion in improving patient concordance with physician direction and guidance is the medical supply-side role in concordance between patient and doctor that involves language, culture, race, and ethnicity 'matches' between provider and patient and patient populations. Could this be integrated into the article somewhere and somehow, or should it become a distinct Wikipedia article? MaynardClark (talk) 20:48, 23 January 2017 (UTC)

References

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Barriers to Adherence

I was thinking it may be beneficial to add more information about the barriers to adherence that are outlined by the World Health Organization. I already have information related to this in my sandbox under the sub-heading Barriers to Adherence. While this draft was initially meant to discuss antidepressant specifically, these barriers are applicable to all classes of medications according to the WHO. Anthonyb9798 (talk) 03:32, 22 March 2018 (UTC)

Hi everyone, I just added to the diabetes section specifically regarding how variations in perceived self-efficacy, risk assessment, immigration status etc. have been proven to be implicated in hindering/decreasing adherence for diabetics. The information included was mostly from meta-analysis and systematically peer reviewed journal articles. I believed this was worthy and relevant to add for diabetes since the disease requires life-long medication management/lifestyle changes and the section was a bit thin. It could possibly good to do this for the other disease/health complication sections as well. X.ay325 (talk) 05:15, 28 November 2021 (UTC)

Compliance factors: duplicate information?

The sentence, "Until recently, this was termed 'non-compliance', which some regarded as meaning that someone did not follow the treatment directions due to irrational behavior or willful ignoring of instructions," seems to duplicate information given under Adherence (medicine)#Terminology, with references to LN Ngoh (2009) and(HH Tilson (2004). OK to remove it from Adherence (medicine)#Compliance factors? Frenezulo (talk) 13:20, 28 November 2018 (UTC)

Adherence barriers

Under the subheading "Health literacy" there is a passage in paragraph 2 that reads "Educational qualifications help to determine an individual's position in the labour market, their level of income and therefore their access to resources." I'm unsure how this relates to health literacy, and it doesn't have a citation. Can we elaborate on this and cite a source(s), or remove it altogether? I'm still new to editing so I would like another's input if possible. If nobody responds, I'll leave it all be. Toodles! 184.100.172.155 (talk) 01:24, 19 September 2023 (UTC)