Treatment adherence. Treatment compliance. On the surface, these terms appear synonymous. After all, if patients adhere to their treatment, aren't they compliant with their treatment? Not quite. The differences between treatment adherence vs. compliance, while subtle in some regards, are important to understand as organizations and providers strive to improve these critical aspects of patient care.
In this blog, we will explore how treatment adherence vs. compliance differs and share some ways organizations and providers can achieve successful improvements.
Definitions of Treatment Adherence vs. Treatment Compliance
Let's begin by reviewing definitions that help contrast treatment adherence vs. compliance.
Treatment adherence, according to the World Health Organization, is "… the extent to which a person's behavior — taking medication, following a diet, and/or executing lifestyle changes — corresponds with the agreed recommendations from a healthcare provider."
Treatment compliance, according to an article in the European Society of Hypertension Scientific Newsletter, defined as "… the degree to which the patient conforms to medical advice about lifestyle and dietary changes as well as to keeping appointments for follow up and taking treatment as prescribed."
An article in Podiatry Today does an effective job of comparing the two concepts when it states the following: "Adherence is an active choice of patients to follow through with the prescribed treatment while taking responsibility for their own well-being. Compliance is a passive behavior in which a patient is following a list of instructions from the doctor."
The article continues, noting, "Adherence is a more positive, proactive behavior, which results in a lifestyle change by the patient, who must follow a daily regimen, such as wearing a prescribed brace. In contrast, compliance is a behavior exhibited by a patient who is simply 'doing as told' or following a list of instructions given by the treating doctor."
Medication Adherence vs. Compliance
We can also gain a greater appreciation of the differences between treatment adherence vs. compliance by briefly reviewing the differences between medication adherence vs. compliance. Medication is, after all, a form of treatment.
Dr. Kraig Shell, in an article for Pharmacy Times, notes that literature often confuses medication adherence vs. medication compliance, as it also does for treatment adherence vs. compliance. This confusion occurs even though, as Dr. Shell states, both terms describe a gap between prescribed behavior and actual behavior. He writes, "I would propose that noncompliance is best defined as gaps that occur for unintentional reasons (or factors beyond the patient's control), while nonadherence is best defined as gaps that occur because of unilateral and intentional decisions to alter therapy."
Dr. Rita Alloway, in a presentation, notes that medication adherence is the "extent to which patients take medications as prescribed by healthcare providers," while medication compliance is the "passive act of the patient to follow the provider's orders."
Treatment Adherence and Compliance Challenges
The differences between treatment adherence vs. compliance become more apparent when examining some potential shortcomings associated with each concept.
There are many reasons why patients may struggle with treatment adherence. When faced with the choice of continuing or stopping treatment, some patients may choose the latter as a means to save money (i.e., reduce cost). As treatment requirements change, patients are often expected to visit new providers and organizations to continue their treatment. These can include specialists, imaging, rehabilitation, and laboratories. If traveling to new providers and organizations proves difficult, patients may elect not to do so.
Finally, if treatment requirements expand, patients may feel overwhelmed by the challenges associated with the coordination of their care. This can include keeping track of who they need to see and when, the frequency of visits, and location for services. If care coordination feels difficult, patients may elect to pursue only some treatments.
There are also many reasons patients may struggle with treatment compliance, which often tie back in some way to patient understanding and expectations. For example, if patients are unhappy with a treatment's effects — whether due to limited signs of improvement, slower improvement than desired, or unexpected side effects — they may try to alter how they approach treatment.
This can also occur when patients experience improvements. If treatment appears to be working, patients may choose to deviate from (i.e., scale back) their regimen because of a belief that continuing the regimen as planned is no longer necessary. As another example, treatment noncompliance can occur when patients fail to understand why they need to follow a regimen or complete specific components of a regimen.
7 Treatment Adherence and Compliance Best Practices
Despite their differences, there are best practices providers and organizations can follow that should help improve treatment adherence and compliance by patients. They are as follows:
- Focus on communication. When providers and patients establish and maintain ongoing, effective communication about and throughout a treatment regimen, the risk of deviation — whether intentional or unintentional — declines.
- Deliver education. As with communication, providing ongoing education about treatment — including its purpose, expected timeframe, potential obstacles to success, and ways to improve success — can help motivate patients to follow and stay committed to their regimen.
- Share resources. Providers and organizations should supplement their communication and education efforts by giving and recommending resources to patients that can help with treatment adherence and compliance. These can include brochures and pamphlets, mobile apps, and videos.
- Provide easily accessible assistance. Many patients will have questions and concerns about and throughout their treatment. Ensure patients know how they can receive timely support. The faster you can address questions and concerns, the more likely it is that patients will not deviate from their regimen.
- Address insurance and treatment cost barriers. As an Advisory Board article notes, adherence is declining as patients face rising costs. The article states, "That's why progressive health systems dedicate staff time to determining whether patients can afford their out-of-pocket costs and to securing financial assistance for patients who need help."
- Treat all patients uniquely. Considering the wide range of potential obstacles to treatment adherence and compliance, do not make assumptions about patients and their ability to adhere and comply with a treatment regimen. Approach each patient with a clean slate. Allocate time to understand what obstacles may hinder an individual's success and then cater your efforts to help the patient by addressing those specific obstacles. Taking a blanket approach to delivering assistance is likely to result in missed opportunities to address particular challenges effectively.
- Don't go it alone. Efforts to improve treatment adherence and compliance are most successful when all stakeholders are involved and work together. This can include patients and their family members, primary care physicians, specialists, nurses, pharmacists, therapists, billers, collections specialists, and even payors. Improving collaboration and coordination between these stakeholders will have a far-reaching and positive impact on treatment adherence and compliance.