Compliance: definitions and key issues.

Issues surrounding treatment compliance can be considered for a number of clinical situations. For clinicians, compliance usually means "the extent to which the patient takes the medications as prescribed." Instead of "compliance," it has been suggested that the term adherence be used, which puts more of a burden on the clinician to form a therapeutic alliance with the patient, which thereby increases behavioral compliance and possibly enhances the therapeutic effect of the medication administered. The trend toward placing more responsibility on the clinician to obtain compliance or adherence to the prescribed treatment has resulted in several strategies. These include explaining the illness and the rationale for the use of medication for its treatment, inquiring into the patient's hesitation and fears concerning medication, and using various educational approaches with the patient and the patient's significant other concerning possible side effects. Different clinical settings and situations also may modify the emphasis needed to maximize compliance. The situation of continuation and maintenance treatment may require a different treatment procedure for maximum success. The emphasis must vary quite a bit from the patient who improves and needs education to be convinced to continue maintenance treatment to the patient who has a treatment-resistant depression and needs close support and maintenance of hope to continue treatment that, up until the present, has not yielded positive results. Shifting the focus of compliance from the patient to the skill of the clinician refocuses the issue from a patient variable back to the art and science of good medicine.(ABSTRACT TRUNCATED AT 250 WORDS)