Adherence vs. Compliance: A Subtle Difference

The number of people being treated for a chronic illness is increasing every year. The interaction and communication that patients have with their doctors about their illness and treatment plan is imperative to chronic disease management and therapeutic control. But sometimes patients just can’t seem to follow through with the medication or treatment that has been recommended to them. Patients must follow a doctor’s guidelines to get well, following these instructions and recommendations is called Medical Adherence and Compliance, but what does that really mean?

Medical adherence is exactly what it sounds like, how well a patient “adheres” to a doctor’s orders. This is an action that the patient takes regarding their medication like filling/refilling their prescription, the dosage recommendations, following the correct schedule and fulfilling the period of time that is needed for effective treatment.

Medical Compliance is a more passive action that involves the patient following the treatment program and taking their medicine routinely. Complying with orders is simply following them correctly, attempting to make lifestyle or diet changes and utilizing the right medical devices or physical therapy at home.

What Concerns Practitioners the Most?

Medical Adherence is a huge concern for doctors as most patients (especially those who are on long-term treatments) do not follow through with taking prescription medications. According to the CDC, these patients either never fill the prescription (20-30% of the time) and almost 50% of patients discontinue their prescription before their treatment plan is complete. As the number of patients with chronic illnesses increases, doctors are even more concerned that the treatment recommendations may not be followed correctly or at all. There is also a direct link between medical adherence and patient costs, the direct costs increase when a patient does not follow treatment plans or prescriptions. These non-adherence patients are also risking hospitalization, emergency visits and even death, by not following doctor’s instructions and/or taking their medications. When patients do not treat their illness, it can progress into a more severe health problem and cause complications that could have been avoided by preventative medical measures.

Why Don’t People Continue Taking Their Prescriptions?

It is estimated that around 10% of prescriptions are filled but never taken and there are many factors (psychological, economical and physical) that influence whether or not the patient will take their medicine correctly.

Physical Factors

Some critical physical factors include things like age, with younger and older patients having the hardest time consistently taking medications. Those patients who have a disability also have difficulty adhering to medicine instructions or guidelines. These instructions can also be quite complex and the involvedness of treatment plans can be a deterrent to use. Another consumer concern is the undesirable side effects that may come from taking a medication. The absence of immediate gratification or results can discourage patients from continuing their plan since they are not seeing the benefit physically.

Economic Concerns

Those with a lower socioeconomic status are less likely to follow medical adherence and prescriptions plans. The costs of repeat medications and the availability of health insurance can make it hard on those with limited income and resources to continue a long-term plan. The treatment cost can be compounded by the length of treatment, with some patients’ budgets not being able to keep up with continuous medication expenses.

Psychological Issues

Some patients have certain mental reservations about medicines that can prevent them from wanting or remembering to take their prescriptions. One issue is the social stigma and stereotypes about some medications, like those for mental health, that impact the user and could be seen as “crutches” to a generally healthy person. The fear of being dependent or hooked on medications is also an upsetting psychological factor that makes the patient not want to take medication that they need for long periods of time. Other patients simply misread the instructions or forget to take medications which can impact their health and the psychological resistance from forming good habits. The lack of motivation and failure in establishing good habits influences the discipline to continue to take medications.

The easiest way to ensure that people take their medications is to have open communication between doctor and patient. It is also important to implement strategies to form healthy, positive habits around taking medication. These positive habits start with making it a priority to fill prescriptions regularly and then actually taking medication. Positive attitudes and motivations can be assisted with tools and technology to help the patient adhere to medical recommendations.

The traditional tools can include using pill boxes to keep track of medications and writing down medication times and instruction details. But recent advances in technology, are making it easier than ever to remember to take medication. Setting alarms on computers or smart phones can remind the patient when to take their medication no matter where they are. Unlike just writing it down or keeping an alarm clock at the home, mobile reminders and visual alarms can help the patient form the habit of following the correct schedule.