While often used interchangeably, medication adherence and medication compliance can be defined differently. Such a distinction is important when organizations set out to improve patient adherence and/or compliance with a medication regimen. By differentiating between the two concepts, organizations can more effectively analyze their performance in each area, identify targeted changes to implement, and then measure the effectiveness of those changes.
Here are four ways medication adherence and compliance differ.
The National Stroke Association (NSA), notes that it's important to recognize the difference between medication adherence and compliance and defines the terms as follows:
- Medication adherence is the "act of filling new prescriptions or refilling prescriptions on time."
- Medication compliance is the "act of taking medication on schedule or taking medication as prescribed."
While there is some overlap between the risks associated with medication non-adherence and non-compliance, there are differences in specifics.
Concerning medication adherence, studies have shown that 20-30% of prescriptions are never filled, according to an Annals of Internal Medicine review. A survey sponsored by the National Community Pharmacists Association (NCPA) conducted among American adults 40 and older who have been prescribed ongoing medication for a chronic condition found that about 28% of patients failed to refill a prescription in time.
NSA notes that poor medication adherence can lead to issues including:
- unnecessary disease progression and complications;
- reduced functional abilities and quality of life;
- additional medical costs and physician visits; and
- unnecessary medication changes.
Concerning medication compliance, the NCPA survey showed that 57% of patients missed a dose, 22% took a lower dose, and 14% stopped taking their medication. A Mayo Clinic Proceedings article notes that approximately 50% of patients with chronic illness do not take medications as prescribed.
The NSA notes that medication non-compliance can lead to hospital stays, with the average length of stay due to medication noncompliance is about four days. The Mayo Clinic Proceedings article notes that patients who fail to take medications as prescribed faced increased risk of morbidity and death and lead to costs for the overall health care system of $100 billion or more per year. One of the significant reasons why? A proportion of days covered (PDC) rate of 80% or more is frequently cited as the threshold needed for optimal therapeutic efficacy.
Why do patients struggle with medication adherence? Reasons can include:
- In a survey conducted by CVS Caremark of more than 2,400 of its retail pharmacists, pharmacists estimated that nearly one-third of customers chose not to fill a prescription due to price.
- Access to a pharmacy. Not all patients can easily get to a pharmacy to fill or refill a prescription.
- Tracking refills. As a patient's number of prescriptions increase, it can be become increasingly difficult to keep track of when medications need to be refilled to avoid gaps in the regimen.
Reasons patients struggle with medication compliance include:
- Fear of side effects. If patients are worried about side effects or experience undesirable side effects, they may try to adjust the regimen to avoid or lessen the effects.
- No signs of improvement or signs of significant improvement. If patients believe a medication isn’t working, they may feel compelled to stop taking the drug. On the other hand, if a medication helps greatly, patients may believe that taking the medication is no longer necessary or may want to preserve the medication in the event that symptoms return.
- Poor tracking. As the number of pills patients must take increases, keeping track of when patients are supposed to take which medication can prove difficult.
- Compliance may suffer if patients do not understand why they need to take a medication or if they struggle to follow prescription instructions.
Here are some quick tips to help your patients improve their medication adherence and compliance.
To help improve adherence:
- Discuss matters such as a patient's ability to pay for medications and their access to a pharmacy during each appointment.
- Recommend generic medications.
- Provide information about prescription assistance programs (e.g., NeedyMeds).
- Provide information about online pharmacies that can help with access issues.
- Advise patients to determine whether their pharmacy offers a refill reminder or automatic refill service.
To help improve compliance:
- At each appointment, ask if the patient is taking their medication on schedule and as prescribed.
- Review possible side effects when changing a regimen and discuss what patients should and should not do when they experience side effects.
- Stress the importance of following a regimen and possible risks of deviation.
- Recommend patients use tools such as pill calendar, pill case, digital dispenser, and mobile app to help with medication tracking.
- Provide patients with information about who they should contact with any questions or concerns about their medication regimen.
- Tailor solutions to specific patient needs and challenges.