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Medication Adherence/Compliance/Persistence: What is the Difference?

Medication adherence is the degree that patients follow (adhere) the directions provided by a healthcare provider.” Medication adherence is measured as  a percentage of medication the patient consumed, following the proper directions, during a time-period. The prescribed directions taken into consideration in this percentage include the number of doses and the dosing interval.

Medication compliance is a term used in the past that is similar to medication adherence. However, there are a few critical differences. The ISPOR work group believes the word compliance means to follow a command. The authors proposed the definition of compliance to include patient conformity to the prescription written by the prescriber, which is measured by the number of doses taken as written. This shows that the patient and prescriber do not have a mutual agreement, and suggests that it is dictated the prescriber. This may lead to patients not take the medication as prescribed because they feel as though they did not agree to this regimen.

Persistence is another term used by ISPOR when talking about medication adherence. Persistence is used to describe patients who continuously use their medications for the prescribed duration. However, during this time the patient may not be taking the medication as prescribed. There are many reasons that patients may not be taking the medication as prescribed, but they are still persisting to take it.  For example, an article in the New York Times discusses how medications are not being taken properly because of the economic burden. An experiment by a Harvard professor showed more patients with zero-dollar co-pays picked up their medications in a timely manner. To help transition patients from just taking their medication, to correctly taking their medication in accordance to route, dose, frequency, and time, health care professionals need to understand why their patients do not take all their medications as prescribed.

Medication adherence and compliance are almost interchangeable terms – though the term adherence is preferred due to the mutual agreement implied versus compliance.  Persistence is often used, and confused, but is important to realize that a persistent patient still desires to take their medication, but something is preventing him/her from doing so.  Overall medication adherence is an important aspect to optimize patient’s drug therapy and it is very important for health care professionals to understand these terms, so they can help patients adhere to their medication regimen.

Urvi Patel, PharmD ‘16


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