Treatment adherence

Abstract

The term 'adherence' is often used incorrectly and synonymously with the term 'compliance'.1 Compliance is the extent to which a patient's behaviour coincides with the medical prescription and recommendations. 2 Adherence, on the other hand, refers to the willingness and ability of patients to follow health-related advice, to take medication as prescribed, to attend scheduled appointments, and to complete recommended investigations.Compliance implies an obligation on the part of the patient to blindly follow the practitioner's instructions, while adherence implies a therapeutic alliance with the practitioner. Previously patients were classified as either adherent or non-adherent but now it is more evident that there is a continuum, with many patients showing some degree of adherence.Patients with psychiatric disorders show a greater degree of non-adherence to treatment than those with physical disorders. 3The adherence rates range from 40 -70% to 60 -92% in the respective disorders. About 30% of all patients with psychiatric disorders discontinue their medication in the first month and 44% discontinue it within the first 3 months of initiation of treatment. Aside from relapse and re-hospitalisation, non-adherence to treatment greatly compromises the efficiency, quality and promptness of care of the community staff. It carries a major direct cost of increased in-hospital treatment and an indirect cost of patient or carer absenteeism from work. 16 Further, these effects are borne not only by the mental health service, but also by the family and wider community. 17 Almost half of these costs could be saved through strategies directed at improving adherence. 18 Therefore, the purpose of this article was to look at the various forms of assessing adherence, the factors associated with adherence, and ways in which to improve adherence.

Follow-up of Mental Care Users by Nurses in the Primary Care Setting in South Africa

“…This in turn fuels the "revolving door" pattern with an increase in recurrence (Parish, 2005;Schwartz, Hiatt, Hargrove & Shaffer, 2007;WHO, 2008) and lower the user's health related quality of care (Klinkenberg & Calsyn, 1996;. Relapse and re-hospitalisation compromise the efficiency, quality and promptness of care by health care staff (Moosa et al, 2007). These effects are not only borne by the mental health service, but also by the family and community, exhausting the limited resources available.…”

“…Nurses are often overworked, demoralised, and they may display a negative attitude. Many present a poor capacity to educated users and this negatively impacts on the provision of continuity of care (Moosa et al, 2007;Uys & Middleton, 2003).…”

Adherence of people with type 2 diabetes mellitus to drug treatment

“…Contudo, dois estudos de revisão (4,22) sobre a adesão medicamentosa no DM, sendo um de revisão sistemática da literatura (22) , apontam que, apesar de uma única dosagem diária favorecer a adesão (4,22) , o risco de super dosagem torna-se maior devido ao esquecimento (22) . Para alguns autores (23)(24) , a super dosagem é considerada um tipo de não adesão.…”

Loss to Follow-Up among a Group of Patients with HIV and Severe Mental Illness in South Africa

“…Multiple factors associated with these poor outcomes have been described, including stigma [15], increased barriers in accessing care, and poor insight and judgment associated with active mental illness [16]. Many of these issues can be alleviated through integrated care programs [17] [18] which have been highly successful in treating persons with HIV and severe mental illness [19] [20]. Even in the best programs, however, a substantial proportion of patients with HIV and mental illness are at risk for becoming "lost to follow up" [21].…”