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.
[10] In medicine, compliance (synonymous with adherence, capacitance) describes the degree to which a patient correctly follows medical advice.
[1] 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.
[6][11] 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.
[14] 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.
[21] The Medical Subject Headings of the United States National Library of Medicine defines various terms with the words adherence and compliance.
[31] In 2013 the US National Community Pharmacists Association sampled for one month 1,020 Americans above age 40 for with an ongoing prescription to take medication for a chronic condition and gave a grade C+ on adherence.
[35] In order to manage medication costs, many US patients on long term therapies fail to fill their prescription, skip or reduce doses.
[37] The elderly often have multiple health conditions, and around half of all NHS medicines are prescribed for people over retirement age, despite representing only about 20% of the UK population.
[38][39] The recent National Service Framework on the care of older people highlighted the importance of taking and effectively managing medicines in this population.
However, elderly individuals may face challenges, including multiple medications with frequent dosing, and potentially decreased dexterity or cognitive functioning.
In children with asthma, self-management compliance is critical and co-morbidities have been noted to affect outcomes; in 2013 it has been suggested that electronic monitoring may help adherence.
[54] General compliance with recommendations to follow isolation is influenced beliefs such as taking health precaution to be protected against infection, perceived vulnerability, getting COVID-19 and trust in the government.
[55] Mobility reduction, compliance with quarantine regulations in European regions where level of trust in policymakers is high can influence whether one complies with isolation rules.
[56] In addition, perceived infectiousness of COVID-19 is a strong predictor of rule compliance such that the more contagious people think COVID-19 is, the less willing social distancing measures are taken, while the sense of duty and fear of the virus contribute to staying at home.
Common barriers include:[72] Health care providers play a great role in improving adherence issues.
A relationship that offers trust, cooperation, and mutual responsibility can greatly improve the connection between provider and patient for a positive impact.
[74] In 2012 it was predicted that as telemedicine technology improves, physicians will have better capabilities to remotely monitor patients in real-time and to communicate recommendations and medication adjustments using personal mobile devices, such as smartphones, rather than waiting until the next office visit.
[84] Other mHealth interventions for improving adherence to medication include smartphone applications,[85] voice recognition in interactive phone calls[86] and Telepharmacy.
[citation needed] Results of a recent (2016) systematic review found a large proportion of patients struggle to take their oral antineoplastic medications as prescribed.
[14] The reasons for non-adherence have been given by patients as follows: Partridge et al (2002) identified evidence to show that adherence rates in cancer treatment are variable, and sometimes surprisingly poor.
The following table is a summary of their findings:[100] In 1998, trials evaluating Tamoxifen as a preventative agent have shown dropout rates of around one-third: In March 1999, the "Adherence in the International Breast Cancer Intervention Study" evaluating the effect of a daily dose of Tamoxifen for five years in at-risk women aged 35–70 years was[103] Patients with diabetes are at high risk of developing coronary heart disease and usually have related conditions that make their treatment regimens even more complex, such as hypertension, obesity and depression[104] which are also characterised by poor rates of adherence.
[105] Other aspects that drive medicine adherence rates is the idea of perceived self-efficacy and risk assessment in managing diabetes symptoms and decision making surrounding rigorous medication regiments.
Perceived control and self-efficacy not only significantly correlate with each other, but also with diabetes distress psychological symptoms and have been directly related to better medication adherence outcomes.
[108] Additionally, it is crucial to understand the decision-making processes that drive diabetics in their choices surrounding risks of not adhering to their medication.
While patient decision aids (PtDAs), sets of tools used to help individuals engage with their clinicians in making decisions about their healthcare options, have been useful in decreasing decisional conflict, improving transfer of diabetes treatment knowledge, and achieving greater risk perception for disease complications, their efficacy in medication adherence has been less substantial.
[109] Therefore, the risk perception and decision-making processes surrounding diabetes medication adherence are multi-faceted and complex with socioeconomic implications as well.
[110] Additionally, variations in patients' perceptions of time (i.e. taking rigorous, costly medication in the present for abstract beneficial future outcomes can conflict with patients' preferences for immediate versus delayed gratification) may also present severe consequences for adherence as diabetes medication often requires systematic, routine administration.
[111] As a result of poor compliance,[citation needed] 75% of patients with a diagnosis of hypertension do not achieve optimum blood-pressure control.