Compliance

Compliance, or adherence, refers to the extent to which patients carry out a recommended treatment regimen. Measurement methods, include self-report, pill counts, biologic markers, and computerized monitoring. Less than of prescriptions are filled and 50% or less of medication is taken as prescribed. Daily dose frequency is inversely associated with compliance: once-a-day (73%), twice-a-day (70%), three-times-daily (52%), and four-times-daily (42%). Medication errors may be inadvertent or intentional and acts of omission or commission. Sociodemographic, economic, and disease related factors are inconsistently associated with noncompliance and of little use in predicting compliance behavior. Regimen-related, patient, provider, health care system, and environmental factors need to be assessed. Simplifying the regimen is the most effective intervention if other concerns do not exist. Critical patient behaviors include making the decision to achieve the desired health outcome, following the regimen as prescribed, monitoring progress toward treatment goals, and resolving problems and barriers that interfere with treatment. Critical provider behaviors include communicating effectively with patients, centering treatment planning on the individual patient, monitoring constantly, and helping patients to resolve problems and barriers. System based approaches include sending reminders, adapting quality assurance procedures to monitor compliance, and evaluating and implementing compliance enhancement programs.