Why we don’t like the term “treatment adherence”

At Folia, we don’t like the term “treatment adherence.” Yes, it’s a standard term across the healthcare ecosystem, and is definitely an improvement on the old “treatment compliance.” However, the concept of adherence still suggests a paternalistic line of thinking, that people who don’t follow prescribed treatment plans must be irresponsible, lazy, defiant, or indifferent.

Imagine that your accountant gave you a list of things to do to better manage your money:

  • Make more money - ask your boss for a significant raise

  • Find a job that requires a less expensive commute

  • Visit your family on the opposite coast only once per year - three times is too expensive

Now, while this advice might help you make and save more money, it’s not good advice because it’s likely not actionable within the context of your life. You would laugh and find a different accountant. You wouldn’t be considered neglectful because you decided not to follow that plan.

“Treatment adherence” minimizes an individual’s agency in deciding to use the treatments that are recommended by his or her clinician. In using a different term, “treatment use”, we acknowledge that there are many reasons why someone may decide not to use all aspects of a treatment plan as prescribed, including:

  • High out-of-pocket costs

  • Incompatibility with the patient’s schedule or life responsibilities

  • Significant side-effects

  • Difficulty accessing the pharmacy or treatment facility

A patient-driven healthcare system requires mutual trust, and it starts with our words.

Once you begin to think of “treatment use”, rather than “treatment adherence”, it opens up the care conversation to include a question of “why.” Why did you decide to use one treatment, and not another? What is causing a problem with something that was prescribed? Now, the clinician can work with the patient and family to fine-tune the treatment plan.

At Folia, switching our language from “adherence” to “use” inspired a new feature - the “Why Not Question”. This allows patients and caregivers the option to indicate why they didn’t use a treatment today. The answers to this question, including reasons like “Couldn’t keep it down” and “Didn’t have time”, came directly from a survey of our users - we found more than 20 common reasons why people don’t use their treatments every time as-prescribed.

Imagine the power of hundreds, or thousands, of people capturing this information. Providers and researchers will have insight into what treatments may not be working for various cohorts because they can’t be taken as prescribed. It will enable providers to understand why patients are making their decisions, and will open the door to discussion and collaboration.

Join us in building a medical ecosystem that uses your knowledge, because your knowledge matters.