ABSTRACT
Introduction ............................................................................................................ 176 Compliance, Adherence, Persistence and Concordance: Explaining Terminology ........................................................................................................... 177
Compliance ....................................................................................................... 177 Adherence ......................................................................................................... 178 Persistence ......................................................................................................... 178 Concordance ...................................................................................................... 178 Recommendation on Terminology: Let Us Stick with Adherence .................... 178
Consequences of Non-Adherence .......................................................................... 179 Whether the Prescription Was Appropriate for the Patient ............................... 179 The Type of Illness and Treatment .................................................................... 179 How We Dene and Measure Non-Adherence ................................................. 180
Cost of Non-Adherence ......................................................................................... 182 Understanding the Causes of Non-Adherence: Towards More Effective Solutions ................................................................................................. 182
The Causes of Non-Adherence: Dispelling Four Common Myths ................... 183 Myth 1: Adherence Rates Are Higher in More Severe Diseases .................. 183 Myth 2: The Non-Adherent Patient .............................................................. 183 Myth 3: ‘Once-a-Day’ Treatments Solve the Problem ................................. 184 Myth 4: Providing Clear Instruction Is Not Enough .................................... 184
The PAPA .......................................................................................................... 185 The PAPA Model ............................................................................................... 186 How Patients Evaluate Prescribed Medication: The Necessity Concerns Framework ........................................................................................ 188
Medication Necessity Beliefs ....................................................................... 188 Medication Concerns .................................................................................... 189
Perceptions of Illness: The Common-Sense Model .......................................... 189 Common-Sense Origins of Medication Necessity Beliefs and Concerns ......... 189
Necessity Beliefs .......................................................................................... 189 Implications for Pharmacy Practice .................................................................. 191
Conclusion ............................................................................................................. 193 Acknowledgements ................................................................................................ 195 Further Reading ..................................................................................................... 195 References .............................................................................................................. 195
Pharmacy practice serves to facilitate the appropriate use of medicines. In traditional approaches to clinical pharmacy, it was thought that this could be achieved by helping to ensure that individual patients received the ‘correct medicine in the correct dose at the correct time’. However, providing a patient with the appropriate
KEY POINTS
• It is thought that approximately half of all medicines prescribed for long-term conditions are not taken as directed.
