Adherence instead of compliance: A new perspective on therapy adherence

Those who regularly take the medication prescribed by their doctor increase their chances of successful treatment. Nevertheless, consistent adherence remains a challenge for many patients. Experts refer to this as treatment adherence—but what exactly does that mean? Terms like compliance and adherence describe this process in different ways. A closer look reveals that this choice of words reflects a fundamental shift in the perception of the patient's role.

Compliance means that the patient follows the doctor's instructions. This sounds positive at first, but it places the patient in a passive role. Doctors prescribe the treatment, and the patient implements it – without input. In a pharmacy, this is something like this: A customer regularly picks up her blood pressure medication, even though she suffers from constant fatigue. She doesn't express any questions or requests. If she later changes the dosage or stops taking the medication, she is considered noncompliant. The classic model views such behavior negatively and doesn't question the patient's personal motivations.

This is where the concept of adherence comes in. It arose because experts felt the one-sided understanding of compliance was inadequate. Adherence means that patient and therapist decide on therapy together. The World Health Organization (WHO) defines it as the degree to which a person's behavior corresponds to the jointly agreed-upon recommendations. The patient is not merely a recipient of instructions but actively participates. Personal responsibility and self-determination are strengthened. The finding: Those who participate in shaping their treatment are more likely to adhere to it.

According to the WHO model, factors affecting the patient therefore constitute only one dimension of adherence. The WHO also lists factors related to the disease, socioeconomic factors, and those related to treatment as additional dimensions. Therefore, in the case of non-adherence, the overall picture should be considered when determining the cause, rather than focusing solely on the patient.