Understanding Medication Management: Why the Term “Adherence”?

Overview:?

• Medication adherence is the preferred term for describing how well patients follow their medication regimens and emphasizes a collaborative relationship between patients and healthcare providers.
• Unlike persistence and concordance, adherence specifically addresses the accuracy of medication-taking and the quality of patient-provider relationships.
• Adherence promotes better patient outcomes by promoting a therapeutic alliance that encourages patients to follow medication regimens through mutual understanding and trust.

The terms persistence, concordance, compliance, and adherence are frequently used synonymously, given they all refer to how well patients take their medication. However, each of these terms has a distinctive meaning, which is crucial to understand given the impact each has on the accuracy of patients' regimens as well as the dynamic between patients and healthcare providers. Persistence addresses the duration a patient continues within their treatment, but does not address how accurately they follow this regimen (Cramer et al., 2008). Furthermore, this term neglects the relationship quality between patients and healthcare providers. These oversights can lead to a simplistic view of medication management that ignores the complexities of patient behavior and the need for a supportive healthcare relationship to achieve optimal outcomes. While concordance reflects a mutual agreement and respect for the patient's views on their medication, it still falls short by failing to address how accurately patients follow their medication regimens (Hugtenburg et al., 2013).

Given compliance and adherence consider both the accuracy of a patient’s medication regimen and the relationship between healthcare providers and patients, they have become leading terms for discussing the suboptimal taking of medication by patients. However, compliance is the degree to which a patient follows a prescriber’s instructions, implying a one-way directive from doctor to patient (Chakrabarti, 2014; Hugtenburg et al., 2013). Given this term's negative connotation, suggesting a one-sided relationship where the patient is expected to obey their healthcare providers without question, adherence has replaced compliance to emphasize a collaborative relationship between patients and healthcare providers. Adherence’s definition emphasizes this dynamic, given it proposes the extent a patient’s medication taking and execution of lifestyle changes correspond with agreed recommendations from a healthcare provider (Chakrabarti, 2014; Hugtenburg et al., 2013). Resultantly, medication adherence is the preferred term as it encompasses the precision of following the prescribed medication regimen and the quality of the patient-provider relationship, promoting better patient outcomes and a more holistic approach to medication management. Notably, the concept of adherence is closely related to the concept known as the therapeutic alliance, a collaborative and trusting relationship between a patient and their healthcare provider (Chang et al., 2019; Pringle & Fawcett, 2017). This alliance is foundational in ensuring patients feel understood and heard throughout their treatment, resulting in patients being more likely to follow through with their treatment plans (Meissner, 1996). Hence, when patients perceive their healthcare providers as partners, they are more motivated and willing to adhere to their prescribed medication regimens. Consequently, medication adherence has become the preferred term as it encompasses the precision of following the prescribed medication regimen and the quality of the patient-provider relationship, promoting better patient outcomes and a more comprehensive approach to medication management.?

References?

Chakrabarti S. (2014). What's in a name? Compliance, adherence and concordance in chronic psychiatric disorders. World Journal of Psychiatry, 4(2), 30–36. https://doi.org/10.5498/wjp.v4.i2.30.?

Chang, J. G., Roh, D., & Kim, C. H. (2019). Association between therapeutic alliance and adherence in outpatient schizophrenia patients. Clinical psychopharmacology and neuroscience: The Official Scientific Journal of the Korean College of Neuropsychopharmacology, 17(2), 273–278. https://doi.org/10.9758/cpn.2019.17.2.273.?

Cramer, J. A., Roy, A., Burrell, A., Fairchild, C. J., Fuldeore, M. J., Ollendorf, D. A., & Wong, P. K. (2008). Medication compliance and persistence: terminology and definitions. Value in Health: The Journal of the International Society for Pharmacoeconomics and Outcomes Research, 11(1), 44–47. https://doi.org/10.1111/j.1524-4733.2007.00213.?

Hugtenburg, J. G., Timmers, L., Elders, P. J., Vervloet, M., & van Dijk, L. (2013). Definitions, variants, and causes of nonadherence with medication: a challenge for tailored interventions. Patient Preference and Adherence, 7, 675–682. https://doi.org/10.2147/PPA.S29549.?

Meissner, W. W. (1996). The Therapeutic Alliance. Yale University Press. https://www.jstor.org/stable/j.ctt32bj01.?

Pringle, J., & Fawcett, J. (2017). Facilitating the therapeutic alliance between pharmacists and patients to improve medication adherence. In D. S. Prescott, C. L. Maeschalck, & S. D. Miller (Eds.), Feedback-Informed Treatment in Clinical Practice: Reaching for Excellence, 299–320. American Psychological Association. https://doi.org/10.1037/0000039-016.??