03 - How common is non adherence

How common is non-adherence?

The Maudsley® Prescribing Guidelines in Psychiatry, Fifteenth Edition. David M. Taylor, Thomas R. E. Barnes and Allan H. Young. © 2025 David M. Taylor. Published 2025 by John Wiley & Sons Ltd. Chapter 14 Working towards adherence What is adherence? The first clear statement about adherence comes from Hippocrates (460–377 bc), who vividly described non-­adherence and linked it with poor outcomes. The World Health Organization (WHO) has described adherence as ‘the extent to which a person’s behaviour  – taking medication, following a diet, and/or executing lifestyle changes – corresponds with agreed recommendations from a healthcare provider’.1 In the UK, the National Institute for Health and Care Excellence (NICE) has, more succinctly, defined adherence as ‘the extent to which the patient’s action matches the agreed recommendations’.2 The more traditional notion of the patient ‘complying’ with the doctor’s orders seems patronising and to deny the agency of the patient.3 ‘Concordance’ is another term that has been used, which seems to refer to an agreement between the patient and the doctor. This is part of the notion of informed consent and is essential for a ‘prescribing partnership’ with patients.4 But, as we know, agreement about a course of action does not necessarily guarantee that the action will happen. Thus ‘adherence’ will be used in this section to refer to the development of behaviours that will, it is hoped, result in better outcomes for our patients. How common is non-­adherence? Large numbers of people, in most areas of medicine, do not seem to take their tablets very regularly – and so can be said to be partly or fully non-­adherent. This is a phenomenon that arises in other clinical areas as well, such as psychological therapies. For people referred to psychotherapy services in the north of England, 34% did not attend for their first assessment session and, of those who did, only 57% subsequently attended the first treatment session.5 Prescribing psychotropics