Turkiye Klinikleri Journal of Medical Ethics-Law and History

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Tedaviye Uyum: Kavramsal Bir Değerlendirme
Compliance, Adherence and Concordance: A Conceptual Evaluation
Betül SÜMBÜL ŞEKERCİa, Özlem BİLDİKb
aBezmiâlem Vakıf Üniversitesi Eczacılık Fakültesi, Klinik Eczacılık ABD, İstanbul, TÜRKİYE
bBezmiâlem Vakıf Üniversitesi Tıp Fakültesi, Tıp Tarihi ve Etik ABD, İstanbul, TÜRKİYE
Turkiye Klinikleri J Med Ethics. 2020;28(2):279-84
doi: 10.5336/mdethic.2019-70795
Article Language: TR
Full Text
ÖZET
 Tedavi uyumuna dair literatürde 'compliance', 'adherence' ve 'concordance' gibi farklı kavramlar kullanılmaktadır. İngilizce literatürde söz konusu kavramlarda görülen değişimin hasta-hekim ilişkisinin yapısındaki farklılaşmaya bağlı olduğu bildirilmektedir. Bu konuda farklı terimlerin bulunması nedeni ile karmaşıklık yaşanmakta, kavramın nitelik ve nicelik olarak kapsamı hususunda muğlaklık bulunmaktadır. Türkçe literatür değerlendirildiğinde ise bu terimler arasında anlam farkı gözetilmeksizin tümünün uyum ve uyunç kelimeleriyle karşılandığı görülmektedir. Bu çalışmanın amacı, literatürümüzde tedavi uyumu konusundaki kavramsal çerçeveyi değerlendirmektir. Bu amaçla öncelikle bahsedilen kavramlar arasındaki farklılıklar ortaya konulmuş ve bu kavramlardaki hasta-hekim ilişkisi, sunulan mevcut modeller ışığında incelenmiştir. Türkçe literatürde uyum kavramının kullanımı incelendiğinde de mevcut kavramsal tartışmanın literatürümüze henüz yansımadığı görülmüştür. Bu bağlamda, öncelikle Türkiye'de mevcut hasta-hekim ilişkisinin gözden geçirilmesi yoluyla bu kavramsal çerçevenin çizilmesi gerekmektedir. Sonuç olarak, hasta-hekim ilişkisinin uyumsuzluğa yol açan etmenlerden biri olmanın ötesinde, bu kavramı şekillendiren temel dinamiklerden biri olduğu görülmektedir. Hastahekim ilişkisine dair sunulan modeller bağlamında bakıldığında, paternalistik bir ilişkiyi yansıtan 'compliance' kavramı için 'tedaviye bağlılık', bilgilendirici bir hasta-hekim ilişkisinde ortaya çıkan 'adherence' kavramına karşılık 'uyum' ve müzakereci bir ilişkiyi vurgulayan 'concordance' kavramı için 'tedavide iş birliği' ifadelerinin literatürümüz için kullanımı önerilebilir.

Anahtar Kelimeler: Uyum; uyunç; kompliyans; hekim-hasta ilişkisi
ABSTRACT
 There are different concepts such as 'compliance', 'adherence' and 'concordance' in the literature on treatment compliance. It is seen that the difference in the concepts in the English literature depends on the change in the structure of the patient-physician relationship. Complexity is experienced due to the use of different terms and there is ambiguity about the quality and quantity scope of the concepts. When the Turkish literature is evaluated, it is seen that all the terms are met with the word 'uyum'/'uyunç' regardless of the meaning difference between these terms. Purpose of this study to evaluate the conceptual framework in our literature on treatment compliance/adherence/concordance. So firstly differences between these concepts have been put forward and the relation to patient- physician relationship in these concepts has been examined in the light of the current models. The conceptual debate on this topic was not reflected on the Turkish literature. Consequently in the context of the patient-physician relationship models, the use of the expressions 'tedaviye bağlılık' for the concept of 'compliance' with a paternalistic relationship, 'uyum' for the concept of 'adherence' with informative relationship and 'tedavide iş birliği" for the concept of 'concordance' with deliberative relationship is suggested for our literatur.

Keywords: Compliance; adherence; concordance; patient physcian relationship
REFERENCES:
  1. Horne R, Weinman J, Barber N, Elliott R, Morgan M. Concordance, adherence and compliance in medicine taking. Report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO). 2005. p.7-160.
  2. Aronson JK. Compliance, concordance, adherence. Br J Clin Pharmacol. 2007;63(4):383-4. [Crossref]  [PubMed]  [PMC] 
  3. Blackwell B. Compliance. In: Fava GA, Freyberger H, ed. Handbook of Psychosomatic Medicine. 1st ed. Madison, Conn.: International Universities Press; 1998. p.625-38.
  4. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008(2):CD000011. [Crossref]  [PubMed] 
  5. Stimson GV. Obeying doctor's orders: a view from the other side. Soc Sci Med. 1974;8(2):97-104. [Crossref] 
  6. Vrijens B, De Geest S, Hughes DA, Przemyslaw K, Demonceau J, Ruppar T, et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012;73(5):691-705. [Crossref]  [PubMed]  [PMC] 
  7. Barofsky I. Compliance, adherence and the therapeutic alliance: steps in the development of self-care. Soc Sci Med. 1978;12(5A):369-76. [Crossref] 
  8. Royal Pharmaceutical Society of Great Britain, Merck Sharp & Dohme. From Compliance to Concordance: Achieving Shared Goals in Medicine Taking. 1st ed. London: Royal Pharmaceutical Society of Great Britain; 1997. p.55.
  9. Segal JZ. "Compliance" to "concordance": a critical view. J Med Humanit. 2007;28(2):81-96. [Crossref]  [PubMed] 
  10. Chakrabarti S. What's in a name? Compliance, adherence and concordance in chronic psychiatric disorders. World J Psychiatry. 2014;4(2):30-6. [Crossref]  [PubMed]  [PMC] 
  11. Kayaalp O. Akılcıl Tedavi Yönünden Tıbbi Farmakoloji, 1-2. 1. Baskı. Ankara: Pelikan Yayınları; 2018. p.1555.
  12. Demirkol ME, Tamam L. [Treatment adherence in psychiatric disorders]. Current Approaches in Psychiatry. 2016;8(1):85-93. [Crossref] 
  13. Çakır F, İlnem C, Yener F. [Compliance to follow-up and treatment after discharge among chronic psychotic patients]. Düşünen Adam Psikiyatri ve Nörolojik Bilimler Dergisi. 2010;23:50-9. [Crossref] 
  14. Toklu HZ, Akıcı A, Keyer Uysal M, Ayanoğlu Dülger G. [The role of the doctor and pharmacist in improving patient compliancein the process of rational drug use]. Türk Aile Hek Derg. 2010;14(3):139-45. [Crossref] 
  15. Üstünsoy Çobanoğlu ZS, Aker T, Çobanoğlu N. [Treatment compliance problem in patients with schizophrenia and othr psychotic disorders]. Düşünen Adam The Journal of Psychiatry and Neurological Sciences. 2003;16(4): 211-8.
  16. Madenci E, İbas E, Koca İ, Altındağ O. [Effect of patient follow-up system on the treatment compliance of osteoporotic patients and on quality of life]. Türk Osteoporoz Dergisi. 2014;20: 46-50. [Crossref] 
  17. Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA. 1992;267(16):2221-6. [Crossref]  [PubMed] 
  18. Veatch RM. [Biyoetiğin Temelleri]. Çeviren Güven T. İstanbul: AND Yayıncılık; 2010. p.58.
  19. Szasz TS, Knoff WF, Hollender MH. The doctor-patient relationship and its historical context. Am J Psychiatry. 1958;115(6):522-8. [Crossref]  [PubMed] 
  20. Gabe J, Bury M, Elston MA. Key Concepts in Medical Sociology. 1st ed. London; Thousand Oaks, CA: Sage Publications, 2004. p.107-11.
  21. Schapira K, McClelland HA, Griffiths NR, Newell DJ. Study on the effects of tablet colour in the treatment of anxiety states. Br Med J. 1970;1(5707):446-9. [Crossref]  [PubMed]  [PMC] 
  22. Beyazyüz M, Göka E. hasta [Bedenin Ruhu]. 1. Baskı. Ankara: CK Yayınevi; 2012. p.208.
  23. Horne R, Weinman J. The theoretical basis of concordance and issues for research. In: Bond C, ed. Concordance: A Partnership in Medicine-Taking. 1st ed. London: Pharmaceutical Press; 2004. p.119-36.
  24. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001;26(5):331-42. [Crossref]  [PubMed] 
  25. Sanduzzi A, Balbo P, Candoli P, Catapano GA, Contini P, Mattei A, et al. COPD: adherence to therapy. Multidisciplinary respiratory medicine. 2014;9(60):1-9. [Crossref]  [PubMed]  [PMC] 
  26. Milburn HJ, Cochrane GM. Compliance and concordance with treatment. Treating the patient as a decision maker is not always appropriate. BMJ. 1997;314(7098):1906. [Crossref]  [PubMed]  [PMC] 

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