(Circulation. 1998;97:127.)
© 1998 American Heart Association, Inc.
Compliance, Adherence, Concordance
Robin Fox, FRCP
Your patient has heart failure, and you
prescribe several medications. At the next visit, there is negligible
improvement, and you increase the doses. But are you sure that the
patient has been taking the pills as prescribed? In a chronic disorder,
the likelihood of noncompliance can exceed 50%. At first sight,
"failure to comply" seems to describe a conflict between the
doctor's rationalism and the patient's irrationalism; but matters are
not that simple, and some commentators no longer speak of compliance
but of adherence or even concordance. For best results, the treatment
may have to be negotiated. The American Heart Association has called
for a strategy in which numerous techniques that improve compliance are
applied at three levels: patient, provider, and organization
(Circulation. 1997;95:1085–1090).
In her address during the 70th Scientific Sessions, the president of
the AHA, Martha Hill, spoke of vast gaps between potential and reality
in cardiovascular medicine: between the results of
trials and those achieved in practice, between intention and action,
between information and behavior. These gaps, she declared, can be
narrowed by greater integration of social and behavioral sciences with
the biosciences: "Professional and patient education now requires
active learning techniques and consideration of cultural and
environmental factors. This is where interdisciplinary teams with the
appropriate mix of expertise and competencies can maximize patient
outcomes."
During the sessions, several presenters discussed the gaps, but
none described controlled trials of interventions to improve the uptake
of effective treatments. Noting that 60% of rehospitalizations in
congestive . . . [Full Text of this Article]
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