Patient adherence to treatment: three decades of research. A comprehensivereview

Low compliance to prescribed medical interventions is an ever present and c omplex problem, especially for patients with a chronic illness. With increa sing numbers of medications shown to do more good than harm when taken as p rescibed, low compliance is a major problem in health care. Relevant studie s were retrieved through comprehensive searches of different database syste ms to enable a thorough assessment of the major issues in compliance to pre scribed medical interventions. The term compliance is the main term used in this review because the majority of papers reviewed used this term. Three decades have passed since the first workshop on compliance research. It is timely to pause and to reflect on the accumulated knowledge. The enor mous amount of quantitative research undertaken is of variable methodologic al quality, with no gold standard for the measurement of compliance and it is often not clear which type of non-compliance is being studied. Many auth ors do not even feel the need to define adherence. Often absent in the rese arch on compliance is the patient, although the concordance model points at the importance of the patient's agreement and harmony in the doctor-patien t relationship. The backbone of the concordance model is the patient as a decision maker an d a cornerstone is professional empathy. Recently, some qualitative researc h has identified important issues such as the quality of the doctor-patient relationship and patient health beliefs in this context. Because non-compl iance remains a major health problem, more high quality studies are needed to assess these aspects and systematic reviews/meta-analyses are required t o study the effects of compliance in enhancing the effects of interventions .