What is Adherence and How is it Different from Compliance? A Team Approach to Establishing COPD Treatment Goals
Posted on March 02, 2016 |
This guest post was authored by Kimberly Driscoll, Ph.D. Dr. Driscoll is licensed clinical psychologist specializing in the use of technology to improve patient adherence and is a member of the PRAXIS Advisory Board. This is the first in a series of posts Dr. Driscoll will write for the PRAXIS Nexus on this topic.
The World Health Organization defines adherence as “the extent to which a person’s behavior, in terms of medications, following diets, or executing lifestyle changes corresponds with agreed recommendations from a health care provider.”1 In recent years, the term adherence has replaced the term compliance because of increasing recognition that engagement in the management of one’s disease is a partnership between the patient and the medical team, whereas compliance infers that a patient must follow “the doctor’s orders.”
Nonadherence to medical treatment regimens is a significant public health concern accounting for hundreds of billions of dollars in health care expenditures because of increased health care utilization and associated complications. For example, COPD nonadherence (e.g., continued smoking, failure to use long-acting bronchodilators) has significant health implications because of its potential to increase morbidity and mortality. Current estimates suggest that approximately 50% of patients with a chronic medical condition are nonadherent to their treatment regimens.
There is no question that adherence to medical treatments, including COPD, requires a significant amount of work. Collaborative discussions between patients with COPD and their healthcare providers that lead to effective problem solving are likely to lead to better chronic illness management. Moreover, establishing proactive strategies and patterns of communication are essential and include: 1) collaborative goal-setting and selection; 2) information collection, processing, and evaluation; 3) decision making; 4) implementing treatment-related actions; and 5) managing emotional reactions to illness and treatment adherence.2
Collaborative goal-setting and selection. It is important to identify daily adherence goals (e.g., taking inhaled corticosteroids a certain number of times per day) and ways to improve quality of life (e.g., reducing morbidity); however, it is equally important to recognize that there may be a mismatch between the healthcare provider’s goals and the patient’s goals. When these situations arise it is important to work with everyone involved to determine realistic and manageable goals.
Information collection, processing, and evaluation. Data collection can be a helpful tool to engaging patients in discussion about improving adherence. Asking very specific questions and encouraging honesty about adherence are recommended.
Decision Making. Shared decision making is a concept that has become increasingly important clinically and in research studies. Decisions between patients and physicians should be shared so that patient preferences about medical treatment are central to the conversation with the physician.
Implementing treatment-related actions. Just because the patient is an adult does not mean that she or he is able to manage the treatment regimen independently all of the time. It may be helpful to think of the management of COPD as a team effort. There may be times when a patient with COPD needs help (e.g., reminders to take respiratory medications, a partner in physical activity).
Managing emotional reactions to illness and treatment adherence. It is important for patients with COPD to develop positive coping strategies for stressors related to managing a chronic illness such as COPD exacerbations and hospitalizations. Negative emotional coping (e.g., depression, anxiety) can serve as a barrier to treatment adherence.
1. World Health Organization. Defining adherence in Adherence to long term therapies: Evidence for action. 2003. Available at: http://apps.who.int/medicinedocs/pdf/s4883e/s4883e.pdf
2. Drotar D. Strategies of adherence promotion in the management of pediatric chronic conditions. J Dev Behav Pediatr. 2013;34:716–29