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April 1995
PEP Pioneers
Second Wind
Torrance, California
Dear Friends,
The extent to which patients follow their doctors' orders in terms of medications and/or the use of medical devices is called adherence or, sometimes, compliance. Adherence or compliance refers to how faithfully the person takes their medicine or does a therapeutic procedure, according to how it is prescribed. Today there is a lot of study concerning the factors of patients' responses to the physicians' advice, such as a medication, diet, activity, or whatever. It stands to reason that appropriate therapy will work better and more often if it is followed than if it is not followed.
Recent studies have indicated that the act of adherence itself helps to determine outcome. This is true even when patients receive a placebo, i.e., a non-active comparison product in a drug trial. Thus, those who adhere to a treatment plan for a drug improve more if they closely adhere to the treatment plan, even though they are not receiving the drug under study. This is a so-called placebo effect. In a repeat heart attack study, for example, the survival was about twice as good in those who adhered to the prescribed treatment, compared with those who didn't, even when only a placebo was given.
Why should this be? One possibility is that the mere act of following advice is indicative of other favorable factors that may promote health, such as diet, exercise, or rest. Adhering to a medical regime may also be symbolic of the individual who is attempting to exert his/her control over their disease process. It is a mind over matter notion. Whatever the reason is why good adherence produces a better outcome, certainly requires further study. Additionally, we ought to be finding better ways to make adherence possible. Prescribing long-acting medications that can be taken once or twice a day is one approach. People can often remember to take a once or twice-a-day product, i.e., morning or night, by putting the medicine in the bathroom near the toothbrush as a reminder. Very few people regularly remember to take a medication four or five times a day unless they are reminded by some sort of timing signal.
The adherence/compliance issue really becomes complicated in the case of addiction such as when tobacco, alcohol, or compulsive behavior dominates the life of the person. Everyone is different but the factors that promote or interfere with adherence are quite complex. In any case, I will adhere to my plan of being in touch with you again next month. It makes me feel good!
Sincerely yours,
Thomas Petty, MD
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