Compliance (medicine)
Compliance in medicine, also referred to as medical adherence, describes the degree to which patients follow the medical advice provided by healthcare professionals. This concept is particularly significant for individuals managing chronic conditions, such as heart disease and diabetes, and also applies to the correct use of medical devices. Various factors can influence a patient’s ability to comply, including their relationship with healthcare providers, financial costs associated with treatment, and the overall complexity of medical instructions.
In discussions of compliance, terminology plays a crucial role. The term "noncompliant" has traditionally been used for patients who do not follow medical advice; however, this has been criticized for potentially labeling patients as uneducated or negligent. Many in the medical community now prefer "adherence," which acknowledges the complexity behind noncompliance, recognizing that various barriers may affect a patient's ability to follow treatment plans.
Poor medical compliance can lead to serious health consequences, including increased mortality rates and hospitalizations, as well as significant financial burdens on healthcare systems. Efforts to enhance medical compliance include simplifying medication regimens, improving patient-provider communication, and utilizing strategies like medication reconciliation, where patients and providers collaboratively review and optimize medication use. These approaches aim to foster better health outcomes and reduce costs associated with nonadherence.
Subject Terms
Compliance (medicine)
Also known as medical adherence or capacitance, medical compliance describes the extent to which a patient follows the medical advice of their medical professional. This is most commonly applied to taking medications for ongoing or chronic conditions, such as heart disease or diabetes, but can also be applied to the use of medical devices, such as continuous positive airway pressure (CPAP) machines and home-use medical devices. Factors that affect compliance include the patient’s relationship with their medical professional and the cost of healthcare and insurance, which often do not completely cover the costs of medical prescriptions or follow-up visits.
Compliance is often mistaken with medication adherence, which is the act of filling new prescriptions or refilling prescriptions on time. Compliance is also thought to be similar to medical concordance, which is when a patient and medical professional make joint decisions regarding the patient’s treatment plan. However, both of these terms differ from medical compliance, the lack of which is an ongoing barrier to the effectiveness of healthcare treatments.
Background
Patients who do not follow health recommendations prescribed by their medical professionals have traditionally been referred to as "noncompliant." However, some medical organizations, including the World Health Organization (WHO), believe that the term associates those who fail to follow treatment instructions as uneducated or willfully ignorant. Instead, WHO and other organizations advocate the term "adherence" as they feel that this term better shows the more varied reasons why a patient may not follow medical instructions or treatment directions, either fully or in part, and avoids blaming the patient for issues that may be beyond their control.
Although the debate over compliance terminology is far from over, medical compliance is a serious issue that greatly affects patient health. Poor medication compliance was a factor in more than 125,000 patient deaths and up to 25 percent of all hospitalizations in the United States in 2018, according to WHO. Nonadherence also increases medical costs, both for patients and taxpayers.
There are many obstacles in trying to improve rates of medical compliance. These include the ways in which medication is prescribed, a lack of communication between patients and medical professionals, and a lack of understanding in how medication or treatment can tangibly benefit a patient, as well as financial barriers. Medical professionals have tried to rein in the rates of nonadherence by making medication instructions simpler, sending reminders, and scheduling regular checkups to make sure that medical compliance is adhered to.
Improving Medical Compliance Rates
Medical professionals have explored many ways to make patients more compliant with medication instructions and regulations, as noncompliance cannot simply be attributed to patients’ stubbornness or resistance to treatment. One method that has seen success, particularly among older patients and those who have multiple chronic conditions that are difficult to manage simultaneously, is to have scheduled appointments that focus exclusively on medication reconciliation.
Medication reconciliation is the process in which a medical professional compiles a list of all drugs a patient is taking, including drug name, dosage, and frequency of use, and works with the patient to ensure that they are using the drugs appropriately and making any adjustments as needed, including simplifying the patient’s drug regimen and recommending less costly generic versions of expensive brand-name medications to increase affordability. These appointments can be structured as interviews on how the patient is using their medications along with so-called brown bag reviews, in which the patient brings in all of their current medications for the medical professional to review. These reviews allow the patient and medical professional make decisions together to improve the patient’s drug and medical compliance rates and help avoid future treatment, thus reducing the health risks for the patient and medical costs for both patients and taxpayers.
Bibliography
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