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The terms compliance, adherence, concordance, and persistence are used to characterize important aspects of medication-taking behaviour. According to the International Society for Pharmacoeconomics and Outcomes Research Medication Compliance and Persistence Work Group, medication compliance (or adherence) is defined as ‘the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen’; while medication persistence is ‘the duration of time from initiation to discontinuation of therapy’.1 The medical profession is well aware that non-adherence to recommended medications represents a worldwide problem, encompassing a large variety of illnesses, treatments, and age groups. Non-adherence leads to worrying consequences, for patients, health professionals, and healthcare systems. According to the World Health Organization (WHO), almost 50% of patients do not take medications as prescribed,2 and evidence shows that non-compliance with medications leads to an inadequate control of the illness, placing patients at a higher risk for complications and adverse outcomes.3–5 Expenditure on direct and indirect consequences of non-adherence to treatment (e.g. hospital admissions, underutilized drugs, and disease progression) represents a substantial burden for healthcare systems.6Indeed, in 2003 the WHO called for initiatives to improve adherence in chronic conditions, claiming that ‘increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatment’.2 Non-adherence is a frequent phenomenon: approximately only one-third of patients fully comply with prescribed treatment.6 For long-term therapies, adherence begins to decline within the first 10 days. Clinical and economic consequences are huge: in the USA 43% of the general population, 55% of the elderly, and 54% of teenagers are not compliant with their treatment causing 10–25% of hospital and nursing home admissions as well as 125 000 deaths annually. The costs for the …

Atrial fibrillation and the 'other drug problem': reducing non-adherence with technology