Shift from compliance to therapeutic adherence in the health care of patients with chronic diseases. A theoretical analytical study

Abstract

For centuries, the Biomedical Model has contributed to improving the health of populations. Its success in increasing longevity was considerable, as evidenced by the decline in infectious diseases, which have given way to chronic diseases. These diseases are related to lifestyles and require long-term treatment, and this is where the biomedical model finds its limits. The current analysis demonstrates the contribution of health psychology to the evolution of patient care. Previously, compliance to treatment was viewed passively (following medical instructions). Now, it has been replaced by adherence to treatment, whereby the patient becomes an active participant in the implementation of his medical treatment. During this evolution, new concepts emerged, and others were added to clarify how to achieve and maintain treatment adherence. The challenge of modern medicine is to work on the behaviors of populations at risk or affected by chronic diseases. Health Psychology helps us to understand health-related behaviors. This analytical study focuses on one aspect of health behaviors: therapeutic compliance and adherence, which highlight the doctor-patient relationship. Poor compliance with long-term treatments for chronic diseases often leads to complications related to the development of various pathologies due to non-compliance with medical prescriptions. Therapeutic compliance is supposed to aim to improve the patient's health. But it turned out that patients do not meet all the expectations of the medical prescriber. Our interest is to identify the issue of therapeutic observance. In this context, several notions are often used to designate the same practice, i.e., following medical prescriptions, such as observance or compliance, which is the least used, adherence, which is the most used, concordance, persistence, and empowerment. Each notion refers to a semantic point of view; our objective is to present these concepts and thus clarify the determinants of the health behavior that is therapeutic adherence.