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Every second patient interrupts therapy — how does this affect your daily practice?
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In clinical practice, there is an increasing shift away from the concept of compliance, meaning passive obedience to medical recommendations, in favor of adherence, i.e. active participation of the patient in therapy. This is not just a change in terminology, but a fundamental correction of the approach to the treatment of chronic diseases.
In this article you will find specific clinical examples, causes of low adherence and practical ways how you can better support patients in maintaining continuity of therapy in their daily work.
According to the definition of the World Health Organization (WHO), adherence is “the degree to which a patient's behavior—taking medication, following a diet, making lifestyle changes—conforms to the agreed recommendations of a healthcare professional.”
According to the definition of the World Health Organization (WHO), adherence is “the degree to which a patient's behavior—taking medication, following a diet, making lifestyle changes—conforms to the agreed recommendations of a healthcare professional.”
Even the most effective drug therapy will not bring the expected effects if the patient does not use it as directed. WHO data indicate that the average level of adherence in the treatment of chronic diseases in developed countries is about 50%. In practice, this means that every second patient does not implement the therapeutic assumptions on an ongoing basis.
The lack of continuity of treatment translates into worsening disease control, increased risk of complications, more frequent hospitalizations and higher treatment costs. In type II diabetes, non-compliance with the recommendations can increase the total cost of therapy up to three times, mainly due to microangiopathic complications.
Low adherence is a complex problem, its causes are rarely one-dimensional. The World Health Organization (WHO) distinguishes five key categories of factors:
Patient factors
Factors associated with therapy
Characteristics of the disease
Health care system
Social Determinants
In practice, there is often variation in the different components of adherence within a single patient. For example, the patient resorts to drug therapy, but ignores dietary recommendations or does not engage in physical activity. This requires a more precise approach to monitoring and intervention.
In everyday practice, adherence can be difficult to assess. Doctors rely mainly on patient statements, which are not always reliable. Other available methods used in practice are:
The lack of standardized adherence assessment tools makes it difficult to assess the effectiveness of treatment, introduce therapeutic modifications, and plan educational activities.
Failure to comply with therapeutic recommendations by the patient has direct and significant consequences for the diagnosis-therapeutic process. In clinical practice, this means, among other things:
Therefore, adherence assessment should be considered as an integral part of every follow-up visit, as well as the assessment of symptoms, adverse reactions or test results.
Many adherence improvement interventions are low cost and can be implemented even with limited consultation time.
In addition, solutions such as the Doctor.One app allow the doctor to be in contact with the patient also between visits — which is especially important in the treatment of chronic diseases, where face-to-face meetings are too rare to effectively support the continuity of therapy. Asynchronous communication enables a rapid response to the patient's difficulties, and Care Coordinator Support (educator, psychologist, PROM/PREM collector) helps to relieve the burden on the doctor and deepen the therapeutic cooperation. Thanks to this, the patient is not left alone between visits — and the doctor gains a fuller picture of the course of the therapy and more control over its effectiveness.
In the age of personalized medicine and digital models of care, adherence should be considered as a key parameter of treatment effectiveness, not only in scientific research, but above all in outpatient practice. Even short interventions can bring measurable benefits. For example, research on depression therapy shows that a few minutes of motivational sessions with a nurse lead to a significant reduction in the number of treatment interruptions.
Effective adherence support does not require advanced technology or additional time burden. Increasingly, the use of simple, digital tools, for example, short self-assessment forms, which the patient fills out regularly via a mobile application, is increasingly possible. The system can automatically inform the doctor about interruptions in treatment, skipping doses or the appearance of side effects.
As a result, the doctor gains current insight into the implementation of recommendations and possibility prompt intervention before the destabilization of the clinical condition. Importantly, the patient remains an active participant in therapy, which further strengthens his commitment and sense of agency.
