[Thinking differently the patient medication compliance: from an injunctive posture to a working alliance between the patient and the healthcare provider: concepts and determinants]. / Penser autrement l'observance médicamenteuse : d'une posture injonctive à une alliance thérapeutique entre le patient et le soignant - Concepts et déterminants.

Patient compliance is a dynamic behaviour, which varies in time and in shape. The impact of poor adherence is medical (loss of immediate benefits and/or long-term) and economic (direct and indirect costs). Adhering and remaining engaged in the daily drug treatment appear to be a challenge for the chronic patient. In this context, we propose as a first step, to describe the evolution of the wording around adherence. This evolution is underlying the paradigm shifts behind this concept and opens new areas for action. Based on this new angle of view that represents the patient's adherence with its drug therapy, we detail the various factors influencing medication adherence categorized into five dimensions: illness, medication, demographic and socio-economic, patient and/or patient support and care system. The impact of these factors is described and explanatory models underlying explicited. Understanding of the issues underlying adherence to drug treatment will help consider further personalized interventions, multi-faceted response to the multiplicity of influencing factors.

[Treatment adherence as a social ability: a case of patients with schizophrenia]. / L'adhérence thérapeutique vue sous l'angle d'une "habileté sociale": application à une population de patients atteints de schizophrénie.

Psychosocial rehabilitation programs are available for schizophrenic patients to develop social abilities. Taking into account deficits in drug compliance of such patients, psycho-educational programs have been developed to tackle patients' abilities to take their drugs. One year after discharge from psychiatric facilities however, only 50% of the psychotic patients are still compliant with their drug treatment. The aim of our paper is to describe concepts associated with drug adherence as a social ability, and to illustrate these concepts with a program designed for psychotic patients. First, we define the concept of social rehabilitation, second, we describe strategies available to enhance adherence to drug treatment, third, we present a psycho-educational program developed at St. Egrève Hospital, France. This program is centered on the patient's own capacities to become adherent. Individual in-patient consultations, developed by a team of 3 professionals (psychiatrist, pharmacist, nurse) are linked to indiviual follow-up at home. Their scope is to identify specific targets for the patient's self-efficacy to run his drug treatment in an autonomous way.