Abstract
Adherence is defined as patient compliance with agreed treatment recommendation in order to achieve a therapeutic result. It could be described as combination of three behaviors: compliance, persistence and concordance. “Compliance” is the extent to which a person’s behavior is consistent with the medical advice. In practice, this means following the doctor’s recommendations. “Persistence” means systematic and persistent application of therapy. Finally, “Concordance” is the collaboration between the patient and the doctor in the choice of therapy. Adherence is therefore based on: acceptance of the agreed therapy, adherence to its principles and systematic adherence to the recommendations.
In order to reproduce all three of those components, Medical and Diagnostic Center (MDC) in Siedlce, Poland has developed four dimensions to measure adherence in:
-intake of medication,
-registration for and appearance on compulsory medical visits,
-degree to which patient evaluates the importance of taking medication for their health,
-patient’s active participation in caring for their health.
First two dimensions measure patient’s compliance and persistence. The issues therefore concern both the fact that certain measures are taken and their regularity. Two other domains consider patient’s concordance. Importantly, fourth dimension focuses on patient role in their health. It assumes that the patient, who is responsible for his or her health, should not only follow the rules of adherence by participating passively in the treatment process, but should also play an active role: they should maintain adequate nutrition, exercise regularly, restrict the use of stimulants or quit smoking. Patients should also be transparent with their doctors about the medicines they are taking.
Adherence of patients in MDC is evaluated by means of patient interview with open-ended questions, but also by verifying data on patient’s weight, filling out prescriptions and registration for compulsory medical visits, including carrying out of preventive check-ups. This is thanks to connected IT system between primary care facilities and pharmacies.
Studies in European countries show that about half of chronically ill patients have problems adhering to prescribed treatment. Encouraging patients to monitor their behaviors, empowering them in making informed decisions around their heath and holding them accountable are key strategies to minimize non-adherence and ensure effectiveness of therapy.