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General Topics

What is medication compliance?

  • Medication compliance is pivotal for the effective management of various medical conditions and is a key factor in achieving positive health outcomes 1.
  • Non-compliance is a major concern which has led to an increase in the cases of illness, morbidity, and mortality 1.

It has become even more crucial to focus on the underlying causes of illnesses as well as medication compliance to reduce the overall global illness burden.

Medication compliance vs. adherence1-3

The terms compliance and adherence are often used interchangeably, however, there is only a very thin line between adherence and compliance. Compliance can be defined as “the degree to which the patient’s behavior complies with the physician’s recommendation.” Although the term compliance has been used extensively to describe how people take their medications, it can often be described as paternalistic since it relates to a process where the doctor chooses an appropriate course of treatment, which the patient is supposed to follow without question and therefore plays a passive role 1,2.

On other hand, adherence is defined as “the degree to which a person’s behavior, taking medication, adhering to a diet, and/or implementing lifestyle changes, corresponds with agreed recommendations from a health care provider.” Adherence describes a procedure in which the suitable course of therapy is chosen following a thorough conversation with the patient and therefore leads to a balanced relationship between patient and doctors 2,3.

When a patient has a chronic condition that requires prolonged medical attention, compliance and adherence are crucial to ensure an improved health outcome 1.

Importance of medication compliance4,5

The use of drugs does not depend only on the chemical properties of the drugs; rather, it is the result of a complex biopsychosocial process that determines the patient’s choice to take medication or not. However, the conventional medical model often assumes that any treatment based on scientific evidence is always in the patient’s best interest and it would be inappropriate or even irrational for the patient not to follow the doctor’s recommendations for such therapy 2.

Here are several reasons why medications compliance is important 4,5 :

  1. Effective disease management: Various health conditions, such as chronic disease (e.g., hypertension), are managed and controlled by taking the medications as directed by a medical professional ensures that the treatment is effective and that the disease is managed effectively 4.
  2. Improved treatment outcomes: Improved treatment outcomes are closely linked to medication compliance. The drugs can be effective in reducing symptoms, checking disease progression, preventing complications, and enhancing overall health when taken as directed by patients 4.
  3. Preventing disease progression: Consistent medication use is essential for preventing disease progression for some diseases that require long-term management. In conditions like HIV/AIDS, cancer, and organ transplant, for instance, medication compliance is critical to the suppression of the disease, the prevention of relapses, and the success of medical treatments.
  4. Cost-effectiveness: In the area of health care, medication compliance can have a positive impact on cost effectiveness. Patients are more likely to have better health outcomes, requiring less hospitalizations, emergency visits and costly treatments if they comply with their recommended treatment plan. This may lead to a reduction in the cost of health care for both individuals and the healthcare system 6.
  5. Trust in healthcare providers: Patients’ confidence in their healthcare professionals and expertise is shown when they stick to the prescribed regimen. This facilitates a patient and healthcare team collaboration that will lead to better communication, shared decisions making and increased overall health care experience 5.
  6. Improved quality of life: Patients are empowered to take a more active role in their own health care when they follow the prescribed regimen. They will be able to take care of their condition and enjoy an improved quality of life 5.

Overall, compliance with medication is essential for ensuring the effectiveness of medicinal therapy, preventing disease progression, and promoting better health outcomes.

Consequences of non-compliance

Medication non-compliance refers to a situation where individuals do not follow the prescribed medication regimen as directed by their healthcare provider. It can have several consequences, including 4:

  1. Reduced effectiveness: Medicines are intended to treat illness and give remedial advantages when taken as prescribed by the physician. Non-compliance can result in the treatment’s reduced effectiveness or even its complete failure. This could make the illness last longer and cause more symptoms 4.
  2. Disease progression: It may be possible for an underlying condition or disease to progress if the regimen of medicines is not followed. In some of these disease, constant management is necessary to protect against deterioration in symptoms, complications, or damage over time. Non-compliance may contribute to disease progression and could increase the risk of severe complications 7.
  3. Increased healthcare costs: Patients’ health may deteriorate if they do not take their medications as directed, requiring additional healthcare interventions like hospitalization, Emergency visits, or physician visits. The individual as well as the healthcare system would be affected by these additional costs 2.
  4. Poor quality of life: Failure to comply with the requirements may result in a deterioration of quality of life due to symptoms persisting, impaired ability to function and lower levels of overall wellbeing. Individuals may experience persistent pain, discomfort, or limitations in their daily activities, which may adversely affect their quality of life, if they do not take the prescribed medicines 2.

Individuals should communicate with their healthcare professionals about any difficulties or concerns that may arise from the use of medicines in an open manner. Physician can promote, educate, and deliver alternative solutions for addressing medication non-compliance to ensure the best possible results for patients.

Barriers to medication compliance8-11

Patient-related factors 8

  1. Lack of understanding on disease and health literacy.
  2. Lack of involvement in the decision-making process for the treatment.
  3. Due to the high cost and difficulty of treating disease, socioeconomic status is a risk factor for paying treatment costs.
  4. Lack of communication and transportation in the rural areas.
  5. Lack of family or social support can cause poor mental health.

Physician-related factors 8,9

1. Prescribing difficult-to-understand medication regimens to the patient.

2. Communication gap among various healthcare officials like Hospital staff, nurses, and doctors.

3. Inadequate understanding of the patient’s disease history.

4. Prior to prescribing any medication, inadequate knowledge of the patient’s financial situation.

Health system-related factors 8-11

  1. Fragmented health care systems hinder medication compliance, by restricting patient access to effective health care.
  2. Physicians are unable to easily access information from various patient care-related venues due to a lack of health information technology, which compromises patient care, timely medication refills, and patient-physician communication.
  3. Insufficient interaction time between physicians and patients.

Strategies to improve medication compliance8,12

Improvements in treatment and a deeper understanding of different pathways are not immediately beneficial until they undergo testing to demonstrate their possible benefits. A systematic approach should be followed to improve medication compliances:

Improvements in treatment and a deeper understanding of different pathways are not immediately beneficial until they undergo testing to demonstrate their possible benefits. A systematic approach should be followed to improve medication compliances:

  1. Plan appropriate interventions and interviews to fill in the gaps to achieve best medication compliance 8.
  2. Enhance patient literacy and educate patients regarding the key information about the drugs (what, why, how, and how long) and common side effects that patient need to be aware of.
  3. Patient self-reporting is economical and effective but has poor sensitivity and specificity. Therefore, it is necessary to complete these patient reports to ensure the effective use of prescribed drug therapy. Research shows that electronic medication packaging (EMP) devices (such as Medication Event Monitoring Systems, MEMS) and pill counting have been shown to be more accurate and efficient 8,10.
  4. Physicians need to provide specific packaging, such as pill boxes, “unit-of-use” packaging, and special containers indicating the time of dose, as well as medication calendars or schedules that specify the time to take medications, drug cards, medication charts, or information sheets related to medicines to the patients 8.
  5. Countries with a centralized medical database should synchronize prescription refill information between providers, prescribers, dispensers, and patients, and then enter the information into their own systems to create a single, unbiased electronic health record to ensure patient care. Consistent review of these prescription fill data increases the specificity of the process 8,11.
  6. Telemedicine is another emerging tool to bridge healthcare gaps and can be seen as a strong contender to spread awareness of the importance of follow-up and compliance in both developing and developed countries 8.
  7. Friends and family members should be educated, empowered, and motivated to assist the patient in adhering to his or her prescribed routine.
  8. After assessing the patient’s behavioral psychology and medical history, patient centric healthcare paradigms may be prescribed. In improving patient compliance and compliance, it might also be useful to discuss medication or lifestyle changes with the patient on an individual basis as well as mutually agree a system of shared decision making that has evolved over the time of period 8,12.

To read more about “Technological advancements and innovations to improve medication adherence” click here

Conclusion

Medical compliance is about providing safe, high-quality patient care therefore medication non-compliance is a major global healthcare issue. Usage of compliance aids, appropriate motivation, and support have shown to increase medication compliance, however patient education is essential to improve compliance. Effective strategies for improving medication should be identified by healthcare professionals to improve treatment outcomes. It’s only possible to achieve optimal medication compliance with a sustained, coordinated effort with the support of all those who are involved in the healthcare of the patients.

“It takes less time to do things right than to explain why you did it wrong”.- By Henry Wadsworth Longfellow

References

1. Gould E, Mitty E. Medication adherence is a partnership, medication compliance is not. Geriatr Nurs. Jul-Aug 2010;31(4):290-8. doi:10.1016/j.gerinurse.2010.05.004

2. Chakrabarti S. What’s in a name? Compliance, adherence and concordance in chronic psychiatric disorders. World J Psychiatry. Jun 22 2014;4(2):30-6. doi:10.5498/wjp.v4.i2.30

3. Cramer JA, Roy A, Burrell A, et al. Medication compliance and persistence: terminology and definitions. Value Health. Jan-Feb 2008;11(1):44-7. doi:10.1111/j.1524-4733.2007.00213.x

4. Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. Apr 2011;86(4):304-14. doi:10.4065/mcp.2010.0575

5. Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman Med J. May 2011;26(3):155-9. doi:10.5001/omj.2011.38

6. Melnikow J, Kiefe C. Patient compliance and medical research: issues in methodology. J Gen Intern Med. Feb 1994;9(2):96-105. doi:10.1007/BF02600211

7. Kumar A, Mohammadnezhad M, May W. Patients’ Perception of Factors Influencing Noncompliance with Medication among Cardiac Patients in Fiji: A Qualitative Study. Patient Prefer Adherence. 2021;15:1843-1852. doi:10.2147/PPA.S322731

8. Sreetama D. Importance of patient adherence and compliance in the present day. Journal of Bacteriology & Mycology. 2017;4(5):3. doi:10.15406/jbmoa.2017.04.00106

9. Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. Circulation. Jun 16 2009;119(23):3028-35. doi:10.1161/CIRCULATIONAHA.108.768986

10. Lam WY, Fresco P. Medication Adherence Measures: An Overview. Biomed Res Int. 2015;2015:217047. doi:10.1155/2015/217047

11. Elwyn G, Frosch D, Thomson R, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. Oct 2012;27(10):1361-7. doi:10.1007/s11606-012-2077-6

12. Garrity TF. Medical compliance and the clinician-patient relationship: a review. Soc Sci Med E. Aug 1981;15(3):215-22. doi:10.1016/0271-5384(81)90016-8