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Cited by 257Medication Adherence and CompliancePatient-Provider Communication in HealthcarePharmacy and Medical Practices

What’s in a name? Compliance, adherence and concordance in chronic psychiatric disorders

Open access
Chakrabarti, Subho·2014·World Journal of Psychiatry
DOI 10.5498/wjp.v4.i2.30PMC PMC4087153
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Abstract

About half or more of the patients with chronic psychiatric illnesses, either do not take their medications correctly, or completely stop taking them. The problem of poor initial compliance or adherence is often compounded by a continued decline in compliance/adherence over time. The failure to take medicines, adversely affects the outcome of treatment, and places a huge burden of wasted resources on the society. Three terms have been used to describe medication-taking among patients with chronic psychiatric disorders. Compliance is defined as "the extent to which the patient's behaviour matches the prescriber's recommendations". Though compliance has been frequently employed to describe medication-taking behaviour, it has proved problematic because it refers to a process where the clinician decides on a suitable treatment, which the patient is expected to comply with unquestioningly. Studies over the past few decades have emphasized the importance of patients' perspectives in medication-taking, based on their own beliefs, their personal circumstances, the information and resources available for them. Adherence has been used as a replacement for compliance in an effort to place the clinician-patient relationship in its proper perspective. Adherence refers to a process, in which the appropriate treatment is decided after a proper discussion with the patient. It also implies that the patient is under no compulsion to accept a particular treatment, and is not to be held solely responsible for the occurrence of non-adherence. Adherence has been defined as "the extent to which a person's behaviour, taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider". To overcome certain problems in the concept of adherence, a third term concordance has been used. The concept of concordance has evolved from a narrower view, emphasizing an agreement between the clinician and the patient, which takes into account each other's perspective on medication-taking, to a broader process consisting of open discussions with the patient regarding medication-taking, imparting information and supporting patients on long-term medication. It is a process, which entertains patients' views on medication-taking, and acknowledges that patients' views have to be respected even if they make choices, which appear to be in conflict with the clinician's views. Although none of these terms are ideal solutions to understanding the complex process of medication-taking behaviour of patients, the move from compliance to adherence and concordance represents genuine progress in this field, which puts the patient's perceptions at the centre of the whole process.

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  • The cultural shift from the role of the submissive patient to a more egalitarian view of the HCP-patient relationship promoted the decline of the term 'compliance'.

    “The cultural shift from the role of the submissive patient to a more egalitarian view of the HCP-patient/user relationship promoted the decline of the term “compliance”, even leading the Royal Pharmaceutical Society of Great Britain to recommend replacing the term “compliance” with “concordance” [7,29].”

    From Therapeutic Adherence of People with Mental Disorders: An Evolutionary Concept Analysis (2023) · cites this paper as [7]

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3 of the 62 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Leo RJ, Jassal K, Bakhai YD. Non-adherence with psycho- pharmacologic treatment among psychiatric patients. Pri- mary Psychiatry 2005; 12: 33-34
  2. Kikkert MJ. Medication adherence in patients with schizo- phrenia: a means to an end. Thesis, University of Amster- dam, Netherlands, 2010. Available from: URL: http: //dare. uva.nl/document/164057
  3. Haynes RB, Taylor DW, Sackett DL. Compliance in health care. Baltimore: Johns Hopkins University Press, 1979
  4. Fink DL. Tailoring the consensual regimen. In: DL Sackett DL, Haynes RB. Compliance with therapeutic regimens. Bal- timore: John Hopkins University Press, 1976: 110-118

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Authors
Chakrabarti, S.
Affiliations
Post Graduate Institute of Medical Education and Research (IN)
Corresponding author
Chakrabarti, Subho
ORCID
Chakrabarti, Subho
Venue
World Journal of Psychiatry
Publisher
Baishideng Publishing Group Inc.
Published
2014
Volume
4
Issue
2
Pages
30
ISSN
2220-3206 (ISSN-L)
DOI
10.5498/wjp.v4.i2.30
PMC
PMC4087153
OpenAlex
W2005695245
Cited by
257
References
62
Citations by year
2026: 14 · 2025: 29 · 2024: 42 · 2023: 34 · 2022: 37 · 2021: 41 · 2020: 18 · 2019: 8 · 2018: 9 · 2017: 10 · 2016: 9 · 2015: 6
FWCI
8.50
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • World Journal of Psychiatry (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
Keywords
medication adherence, concordance, chronic mental illness, psychiatric medication, patient perspectives, clinician-patient relationship, medication-taking behavior, medication beliefs

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