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Adherence to Therapies

General Information

Adherence and compliance are both terms used to describe the extent to which a patient takes their medication as prescribed.

Compliance is defined as the extent to which the patient’s behaviour matches the prescriber’s recommendations.

Adherence  is “the extent to which the patient’s behaviour matches the agreed recommendations from the prescriber”. It is nowadays preferred by many to compliance because of its emphasis of the need for agreement and that failure to adhere should not be a reason to blame the patient.

Adherence to therapies is an important determinant of treatment success. Poor adherence carries a significant human cost in terms of patient safety and quality of life. It also presents a serious problem for health systems, both in inferior health outcomes, unnecessary treatments and hospitalisations, and in terms of resources wasted through the non-use of prescribed medicines funded by healthcare systems.

“Drugs don't work in patients who don't take them” – the former US Surgeon General is said to have stated. But monitoring what happens after a medicine has been prescribed has been a rather neglected area in healthcare policy. The issuing of a prescription is the first step towards safe and high-quality treatment. However, it is estimated that 20% to 30% of patients do not adhere to medication regimens that are curative or relieve symptoms, and 30% to 40% do not follow regimens designed to prevent health problems.

Concordance is a more recent term which focuses on the patient-prescriber relationship and the degree to which the prescription represents a shared decision. In a concordant process, the beliefs and preferences of both the prescriber and the patient are taken fully into consideration, with the recognition that the patient’s views are paramount. It can  also refer to a wider concept of patient support in medicine taking. Concordance is related to but not synonymous with adherence.

EPF’s Position

EPF believes that improving adherence has the potential to improve the quality of chronic disease care, as well as the overall quality and cost-effectiveness of European healthcare systems. In our view, strategies to increase adherence should focus on health literacy and empowerment, together with appropriate systems to support patients. Well informed patients understand their condition and treatment  process better. They are also more confident in bringing up issues that may impede adherence, such as adverse reactions, with their health professionals.

Implementing truly patient-centred healthcare, including shared decision-making and a concordance approach to prescribing, is essential. We believe that concordance in healthcare decision-making is essential and will lead to higher adherence by the patient. This means that health professionals need to engage with patients as equal partners in the prescribing process, really listening to and taking account of their views.

Key Steps

2015

We released a position paper on EPF strategies to support patient adherence and to set out our principles and recommendations on adherence and concordance.

2011

EPF joined forces with the European umbrella organisations representing doctors, community pharmacists and the pharmaceutical industry, to raise awareness on this vital topic. We held a joint seminar at the European Parliament on 21 September to highlight the scope of this problem and explore solutions. The key message that emerged from the discussion was that a coordinated multi-stakeholder and patient-centred approach – involving patients, their carers/families, health professionals, industry, and the public – is needed to address this major issue.  Such an approach can help improve patient safety and provide patients with high-quality healthcare which responds to their needs.