Defining compliance, adherence and concordance – word power
You may have understood the word ‘compliance’ to be benign and simply used when a patient has not complied with treatment instructions. It is particularly associated with medicine taking although you may find it used to describe any patient non-adherence to instructions given to patients by clinicians.
Compliance is defined as:
'The extent to which the patient's behaviour matches the prescriber's recommendations' (Haynes, Taylor & Sackett 1979). Despite the simplicity of the definition it has been criticised for having power connotations with the power biased towards the clinician; 'do as I say' and the patient being expected to passively follow 'the doctor's orders'.
The term adherence was adopted as a less demeaning alternative word to compliance in an attempt to emphasise that patients are free to decide whether to follow the prescriber's recommendations (Barofsky 1978). Adherence develops the definition of compliance and is elevated slightly by emphasising the need for agreement. There is only one subtle change; 'The extent to which the patient's behaviour matches the agreed recommendations of the prescriber'.
Marinker defines Concordance as being:
‘Based on the notion that the work of the prescriber and patient in the consultation is a negotiation between equals and that the aim is a therapeutic alliance between them. This alliance may include an agreement to differ. Its strength lies in an assumption of respect for the patient's agenda and the creation of openness in the relationship, so that both doctor and patient together can proceed on the basis of reality and not of misunderstanding, distrust or concealment’. (1997 p8)
The Medicines Partnership 2001 further developed this as an:
‘alliance in which the health care professionals recognise the primacy of the patient's decisions about taking the recommended medications’
Within the concept of non-compliance and non-adherence the patient alone may be deemed responsible. However, concordance places the responsibility with the prescriber and the patient; there are two parties involved. The patient alone cannot be non-concordant; concordance is not another word for compliance. The terms compliance and non-compliance continue to be used every day in clinical practice and in the medical, nursing and pharmaceutical literature. Why do you think this might be?
Copyright eBook 2019, University of Leeds, Leeds Institute of Medical Education.