Diabetes Treatment Terms: Compliance vs Adherence

You know just how much we hate the term “compliant,” and especially its antonym “noncompliant”– suggesting a lot of naughty, misbehaving patients who are just too lazy or stubborn to follow orders. Ugh!

It’s been reassuring in the past couple of years to see many healthcare and pharma professionals realizing just how un-PC the term “compliant” is, because it doesn’t reflect the least little empathy for how difficult it’s to execute some pretty unpleasant health activities day in and day out, for the remainder of our lives, often with frustrating results!

Also, “compliance” covers what: eat right, exercise hours each week, get your lab tests often, and test your sugar over and over at a perfect daily drumbeat of diabetes management. NOT.

Recently it seems the industry has broken off a little this, honing in on “medicine adherence. ” I see this term popping up throughout nowadays.

Three of the big chain pharmacies have recently launched “adherence” apps specifically for diabetes:

* Express Scripts Inc. just unveiled a new app for calling people who fail to take their prescription medication — until they actually stop. They’re using innovative data analytics to “accurately forecast as much as a year ahead of time which patients are most at danger of falling off their physician-prescribed drug therapy” and they then intervene by sending reminders, and supplying consultations with a pharmacist, reduced co-pays, transition into home delivery of meds, or auto refills and renewal help.

Decision CVS/Caremark is doing something similar, offering “pharmacist-initiated phone calls, or face-to-face counselling with a pharmacist in a native CVS/Pharmacy,” and supplying members “choices and alternatives to allow them to get the absolute most out of their pharmacy benefit and identify opportunities for cost savings,” together with educational materials.

Decision Walgreens is testing a new “Optimal Wellness” program that provides face-to-face care training with pharmacists within their stores. “Through accessible neighborhood pharmacies, our app brings patients the tools they need to live healthier and more productive lives,” they assert.

I wonder, though, is adherence a different notion to flog patients with? Or is it something parading individual help that’s really just an excuse to push product? If you look carefully — despite the claims to supply patient education — many of the new adherence programs appear suspiciously like campaigns to 1) simply bug people to keep refilling their prescriptions, and 2) self-servingly “extend the pharmacist’s role as a reliable supplier of healthcare services” (a direct quote from the Walgreens press release).

™# delve to people’s data to see who’s been carrying their meds also brings up a bevy of privacy and ethical concerns, as noted a couple of days back in the Wall St. Journal.

™# Is the act of refilling prescriptions the indicator that is ideal?

Would you assume that simply because patients are spending money to refill meds, so they are consuming them frequently and properly?

Well… there is me for example, and that statin medication my endo insisted on. I filled the script right, but afterwards decided that I felt uncomfortable taking them, because my cholesterol had been barely large, and there is still a great deal of controversy over the effects of long-term statin usage. So the tablets sat at my medicine cabinet for a couple of months, until we recently changed insurance providers again and the script was automatically refilled. Snap! I have TWO three-month supplies of a medication I don’t take. I sure as heck don’t want anybody calling me to remind me I haven’t refilled in a while.

™# I actually wonder what the content and quality of the “patient education” portion from these pharmacies would be? We PWDs know full well what variety is different in that stadium.

™# And what happens after patients leave the drugstore? What keeps them motivated over the long haul? As my fantastic CDE Gary Scheiner says, “If people take their health seriously, they will take the meds but inspiration for each individual is about finding something around (diabetes care) that’s important to YOU.”

“If I’m working with a teenager for example, I don’t discuss A1c or normal blood sugar levels in any way. They don’t care about that. I discuss sports performance, academics, social life, and possibly that acne they have got (because when their sugars are large, the skin becomes dried and they will have more skin issues).   That’s the stuff they care about.”

I wonder, can institutional “adherence” programs possibly acknowledge the simple actuality that people don’t care about medical analytics – they care about their own lives?

But I’d like to put the question out into the actual patients living “in the trenches”: what would you believe might help you or alternative PWDs you know become more compliant, er… adherent? Or whatever you want to call it?

Disclaimer: Content created by the Diabetes Mine team. For additional information click here.


This content is made for Diabetes Mine, a customer health blog concentrated on the diabetes community. The content isn’t medically reviewed and does not adhere to Healthline’s editorial guidelines. To learn more regarding Healthline’s partnership with Diabetes Mine, please click here.

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