Medication adherence is a partnership, medication compliance is not.
Medication adherence is a complex phenomenon. As individuals assume greater responsibility for, and participation in, decisions about their health care, teaching and supporting adherence behaviors that reflect a person's unique lifestyle are the essence of a clinician-patient partnership-and it is a perfect fit with assisted living communities and nursing practice. The notion of compliance is an outdated concept and should be abandoned as a clinical practice/goal in the medical management of patient and illness. It connotes dependence and blame and does not move the patient forward on a pathway of better clinical outcomes. This article discusses the differences between compliance and adherence, identifies purposeful and unintentional reasons for nonadherence, and describes assessment tools for adherence, medication effect, and self-management capacity. Drawing on the scholarly work of others, we introduce a model for medication adherence, the ACE-ME Model: assessment, collaboration, education, monitoring, and evaluation. This model draws on the strengths and science of nursing and engages nursing participation in the continuing evolution of adherence strategies. For purposes of clarity in discussing these concepts, we use the word patient in this article rather than the word resident-that is, the older adult living in an assisted living community.
Gould
Elaine
E
Hartford Institute for Geriatric Nursing, College of Nursing, New York University, New York, NY, USA.
Mitty
Ethel
E
D040561:Assisted Living Facilities; D003299:Cooperative Behavior; D005851:Geriatric Nursing; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation / Q000379:methods / Q000523:psychology; D012646:Self Administration / Q000451:nursing / Q000523:psychology*