3 Clinical psychopharmacology3.1 General pharmacology
3.1.3 Compliance and adherence
1 min read
Written by Resident Doctor Committee · Published
Terminology
Term | Meaning |
|---|---|
Compliance | Following the prescriber's instructions |
Adherence | Following an agreed plan, to varying degrees |
Concordance | Sharing perspectives in the consultation |
Persistence | Staying on treatment over time |
Why medication is not taken
Type | Nature | Examples |
|---|---|---|
Intentional | A decision, so reminders alone will not shift it | Adverse effects, stigma, disagreement about need |
Unintentional | A practical barrier, not a choice | Poor memory, complex regimen, cost |
Horne's necessity-concerns framework weighs a person's perceived need for treatment against their worries about it.
Low self-efficacy, low confidence in managing one's own treatment, is consistently linked with intentional non-adherence.
A good therapeutic alliance and clear information promote adherence.
Assessing adherence
No single method is reliable, so combine enquiry, collateral history, dispensing records and plasma levels.
Neither dispensing records nor tablet counts prove the tablets were swallowed: records show supply, and counts only suggest timing and pattern.
Supporting adherence
Match the support to the barrier: reminders and dispensing aids for forgetting, discussion or dose changes for concerns.
Sodium valproate is deliquescent: it takes up water from the air, so its tablets degrade outside their sealed blister and cannot go into a multi-compartment compliance aid.
A long-acting injectable antipsychotic removes daily dosing and makes a missed appointment visible; offer it as a choice, never as a punishment.
Covert administration
Covert administration, hiding medicine from someone who lacks capacity, needs a documented multidisciplinary best-interests decision and pharmacy advice, and never overrides a capacitous refusal.