[Thinking differently the patient medication compliance: from an injunctive posture to a working alliance between the patient and the healthcare provider: concepts and determinants]

Abstract

Patient compliance is a dynamic behaviour, which varies in time and in shape. The impact of poor adherence is medical (loss of immediate benefits and/or long-term) and economic (direct and indirect costs). Adhering and remaining engaged in the daily drug treatment appear to be a challenge for the chronic patient. In this context, we propose as a first step, to describe the evolution of the wording around adherence. This evolution is underlying the paradigm shifts behind this concept and opens new areas for action. Based on this new angle of view that represents the patient's adherence with its drug therapy, we detail the various factors influencing medication adherence categorized into five dimensions: illness, medication, demographic and socio-economic, patient and/or patient support and care system. The impact of these factors is described and explanatory models underlying explicited. Understanding of the issues underlying adherence to drug treatment will help consider further personalized interventions, multi-faceted response to the multiplicity of influencing factors.