Adherence and concordance

Question 1

Adherence versus compliance

Answer 1

• Adherence- The extent to which the patients behaviour matches agreed recommendations from the prescriber
• Compliance- The extent to which the patient’s behaviour matches the prescriber’s recommendations

Question 2

Concordance

Answer 2

• Does not address medicines-taking specifically
• Prescriber and patient should arrive at a harmonious agreement (a Concord) regarding therapeutic decisions that incorporate their respective views
• A concordant consultation, leading to shared decision-making about a prescription can promote adherence

Question 3

Patient-Medicines pathway

Answer 3

Question 4

The scale of non-adherence

Answer 4

• 30-50% of prescribed medication is not taken as recommended
• Cuts across disease states including asthma, HTN, diabetes, HIV/AIDS, dyslipidaemia and epilepsy

Question 5

Measuring adherence

Answer 5

Question 6

Consequences of non-adherence

Answer 6

Question 7

Consequences of non-adherence- health

Answer 7

Question 8

Consequences of non-adherence- economic

Answer 8

Question 9

Implications of non-adherence

Answer 9

• In 2017/18, the NHS in England spent £18.2 billion on drugs
• Estimates for the cost of unused or unwanted medicines in the NHS vary from £100 million to £300 million annually

Question 10

Reasons for non-adherence

Answer 10

Question 11

Health system factors

Answer 11

• Very little evidence on the imopact of health system factors on adherence but
  
  • Healthcare provider communication which was rated as more collaborative (as opposed to non-collaborative) was associated with better adherence to anti-HTN medication
  • Adherence was slightly but significantly higher in patients having their medicines dispensed in an independent pharmacy than in a chain pharmacy (90% and 80%)

Question 12

Adherence to dyslipidaemia medication by age

Answer 12

Question 13

Adherence to dyslipidaemia medication by socioeconomic deprivation

Answer 13

Question 14

Tackling non-adherence

Answer 14

• Across the body of evidence, effects were inconsistent from study to study, and only a minority of the lowest risk of bias RCTs improved both adherence and clinical outcomes
• Current methods of improving medication adherence for chronic health problems are mostly complex and not very effective so that the full benefits of treatment cannot be realised
• The research in this field needs advances, including improved design of feasible long-term interventions, objective adherence measures, and sufficient study power to detect improvements in patient-important clinical outcomes