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Compliance, Adherence and Concordance - two-way processes

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It is relatively easy to stoptaking medications or incorrectly take them either intentionally or unintentionally.This can be described by the term ‘non-adherence' and is often easily done, especiallywhen patients are taking more than one medication (NICE, 2009). There are manyother reasons for non-adherence such as a lack of understanding of thetreatment or side effects.  

In addition, the terms ‘compliance'and ‘concordance' are also used and defined separately. Concordance is theshared decision making process between the patient and the pharmacist. Althoughthere has been a greater drift towards the terms adherence and concordance, theterm compliance is still commonly used. In my opinion, a useful and detaileddefinition is as follows:

‘Patient compliance with prescribed andnon-prescribed medications is defined as patient understanding and adherence tothe directions for use. The compliant patient follows the directions for takingthe medication properly and adheres to any special instructions provided by theprescriber and/or pharmacist. Compliance includes taking medication at thedesired strength, in the proper dosage form, at the appropriate time of day andnight, at the proper interval for the duration of the treatment, and withproper regard to food and drink and consideration of other concomitantmedications (both prescribed and non-prescribed) and herbal remedies (Ansel andStoklasa, 2006).

I have briefly describedinterventions that are in place which help to improve patient compliance,concordance and adherence such as MURs, NMS, patient counselling (especiallyduring repeat prescribing) and communication all of which are evolving roles ofthe pharmacist. Most importantly, these are not just one-way processesinvolving only the pharmacist, but also require the patient's contribution.

The patient should be involvedand allowed to make decisions regarding their care. Furthermore, the pharmacistneeds to verify the patient's understanding in regards to their treatment especiallyif they have a reason for not taking their medication.  This two-way communication is essential andcould be a barrier not only to compliance but to concordance and adherence.

Useful sources:

Ansel, H.C. and Stoklasa, M.J.,2006. Pharmaceutical Calculations. 12thed. Baltimore: Lippincott Williams and Wilkins.

NICE, 2009. Medicines adherence: Involvingpatients in decisions about prescribed medicines and supporting adherence. Clinical guideline 76. [pdf] London:  National Institute for Health and ClinicalExcellence. Available at: < http://www.nice.org.uk/nicemedia/live/11766/42891/42891.PDF > [Accessed 26 December 2011].

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