Adherence to treatment, the extent to which patients are able to follow the agreed recommendations for prescribed treatments with healthcare provider, is a key component of chronic disease management.
Does mHealth increase adherence to medication?
Abstract. It is well known that patient adherence to appropriately prescribed medications is essential for treatment efficacy and positive therapeutic outcomes. It is also understood that patients who are prescribed medications do not necessarily take them as prescribed.
How to improve medication adherence?
· Treatment adherence, according to the World Health Organization, is "… the extent to which a person's behavior — taking medication, following a diet, and/or executing lifestyle changes — corresponds with the agreed recommendations from a healthcare provider." Treatment compliance, according to an article in the European Society of Hypertension …
Can mHealth help with medication adherence?
Fragmented health care systems create barriers to medication adherence by limiting the health care coordination and the patient's access to care. 66 Prohibitive drug costs or copayments also contribute to poor medication adherence. 35,67 Health information technology is not widely available, preventing physicians from easily accessing ...
Can home delivery Meds improve adherence?
adherence to treatment: The following by a patient of a recommended course of treatment—e.g., taking all prescribed medications, adhering to a recommended diet and exercise plan and reducing or eliminating alcohol or tobacco intake, and so on.
What is the meaning of treatment adherence?
Treatment adherence, according to the World Health Organization, is "… the extent to which a person's behavior — taking medication, following a diet, and/or executing lifestyle changes — corresponds with the agreed recommendations from a healthcare provider."
What does adherence mean in healthcare?
Adherence has been defined as “the extent to which a person's behaviour, taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider”.
What is a barrier to health treatment adherence?
The barriers to medication adherence included four concepts, namely, lifestyle challenges, patient incompatibility, forgetting of medicine use, and nonexpert advice. These concepts are always present in the disease process and reduce the patients' efforts to achieve normal living and adhere to the medication.
Why do patients not adhere to treatments?
There are many causes of non˗adherence but they fall into two overlapping categories: intentional and unintentional. Unintentional non˗adherence occurs when the patient wants to follow the agreed treatment but is prevented from doing so by barriers that are beyond their control.
What does lack of adherence mean?
1 an insufficiency, shortage, or absence of something required or desired. 2 something that is required but is absent or in short supply.
What is adherence nursing?
Adherence is the extent to which someone follows an agreed set of actions. It assumes an equal relationship between two people and is a voluntary process. In healthcare, it usually relates to: Making lifestyle changes; Taking prescribed medication (National Institute for Health and Care Excellence, 2009);
What are the common barriers to adherence?
Barriers to good medication adherence according to the general practitioners (GPs)Poor knowledge of the illness and medication.Administering and dosage of the medication.Independent pausing, stopping or controlling of the medication.Lack of competence in self-management.More items...
What are some factors that can interfere with patient compliance in treatment plans?
This list of potential barriers included:Demographic factors such as age, ethnicity, gender, education, marriage status.Psychosocial factors: beliefs, motivation, attitude.Patient-prescriber relationship.Health literacy.Patient knowledge.Physical difficulties.Tobacco or alcohol intake.Forgetfulness.More items...•
How can medication adherence be improved?
Nine Tips for Improving Medication AdherenceEducate patients about what to expect. ... Nurture relationships with patients. ... Team up with prescribers. ... Engage the staff. ... Learn about and use available technologies. ... Help patients customize their support tools. ... Schedule appointments. ... Synchronize medications.More items...•
Why is treatment adherence important?
Taking your medicine as prescribed or medication adherence is important for controlling chronic conditions, treating temporary conditions, and overall long-term health and well-being. A personal connection with your health-care provider or pharmacist is an important part of medication adherence.
What are adherence factors?
Adherence is a multifactorial phenomenon that can be influenced by various factors. These factors can be divided into five different dimensions: social and economic factors, therapy-related factors, disease-related factors, patient-related factors and health care system-related factors [10, 11].
What are the consequences of non-adherence?
Consequences of nonadherence include worsening condition, increased comorbid diseases, increased health care costs, and death. Nonadherence results from many causes; therefore, no easy solutions exist.
Why is patient adherence important?
It is well known that patient adherence to appropriately prescribed medications is essential for treatment efficacy and positive therapeutic outcomes. It is also understood that patients who are prescribed medications do not necessarily take them as prescribed. Indeed, variation in patients' medicat ….
Why is adherence important in medicine?
It is well known that patient adherence to appropriately prescribed medications is essential for treatment efficacy and positive therapeutic outcomes. It is also understood that patients who are prescribed medications do not necessarily take them as prescribed. Indeed, variation in patients' medication-taking is an age old conundrum which remains the focus of much interest amongst researchers and clinicians owing to its far-reaching consequences. Despite the extensive adherence-related research over the last four decades and a recent surge in this field, there remains a lack of uniformity in the terminology used to describe adherence and its related concepts. In turn, it is often difficult to conduct comparisons between adherence-related studies, which may be associated with the non-cumulative nature of work in this field. The purpose of this commentary is to provide an overview of key terminology relating to the field of adherence research.
What is variation in patients' medicat?
It is well known that patient adherence to appropriately prescribed medications is essential for treatment efficacy and positive therapeutic outcomes. It is also understood that patients who are prescribed medications do not necessarily take them as prescribed. Indeed, variation in patients' medicat ….
What is treatment adherence?
Treatment adherence, according to the World Health Organization, is "… the extent to which a person's behavior — taking medication, following a diet, and/or executing lifestyle changes — corresponds with the agreed recommendations from a healthcare provider."
Why do patients struggle with treatment compliance?
There are also many reasons patients may struggle with treatment compliance, which often tie back in some way to patient understanding and expectations. For example, if patients are unhappy with a treatment's effects — whether due to limited signs of improvement, slower improvement than desired, or unexpected side effects — they may try to alter how they approach treatment.
What stakeholders are involved in adherence and compliance?
This can include patients and their family members, primary care physicians, specialists, nurses, pharmacists, therapists, billers, collections specialists, and even payors. Improving collaboration and coordination between these stakeholders will have a far-reaching and positive impact on treatment adherence and compliance.
How to treat all patients?
Approach each patient with a clean slate. Allocate time to understand what obstacles may hinder an individual's success and then cater your efforts to help the patient by addressing those specific obstacles. Taking a blanket approach to delivering assistance is likely to result in missed opportunities to address particular challenges effectively.
What resources should providers and organizations share?
These can include brochures and pamphlets, mobile apps, and videos.
How to motivate patients to follow a regimen?
Deliver education. As with communication , providing ongoing education about treatment — including its purpose, expected timeframe, potential obstacles to success, and ways to improve success — can help motivate patients to follow and stay committed to their regimen.
Why do patients try to alter how they approach treatment?
For example, if patients are unhappy with a treatment's effects — whether due to limited signs of improvement, slower improvement than desired, or unexpected side effects — they may try to alter how they approach treatment. This can also occur when patients experience improvements.
What is the definition of adherence to long term therapy?
The WHO defines adherence to long-term therapy as “the extent to which a person's behavior—taking medication, following a diet, and/or executing lifestyle changes—corresponds
How does medication adherence affect the health of the population?
In its 2003 report on medication adherence,1the World Health Organization (WHO) quoted the statement by Haynes et al 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 treatments.” Among patients with chronic illness, approximately 50% do not take medications as prescribed.1,2This poor adherence to medication leads to increased morbidity and death and is estimated to incur costs of approximately $100 billion per year.3Thus, Hippocrates' exhortation to the physician to “not only be prepared to do what is right himself, but also to make the patient…cooperate”4has consistently failed for more than 2000 years. Today's ever more complicated medical regimens make it even less likely that physicians will be able to compel compliance and more important that they partner with patients in doing what is right together.
How long does it take for secondary prevention to decline?
Persistent use of secondary preventive drugs declines rapidly during the first 2 years after stroke.
What are the complications of hypertension?
Cardiovascular complications resulting from hypertension, hyperlipidemia, and diabetes lead to substantial disability, morbidity, and mortality. For example, for every increase of 20 mm Hg in systolic BP and every increase of 10 mm Hg in diastolic BP, the risk of stroke and ischemic heart disease doubles.7Because of this increased risk, comprehensive treatment plans for patients with established CVD include antidiabetes, antihypertensive, and lipid-lowering (typically statin-based) therapies for patients who present with diabetes, hypertension, and dyslipidemia, respectively.8
How to determine if a patient is adherent to medication?
Patients are generally considered adherent to their medication if their medication adherence percentage, defined as the number of pills absent in a given time period (“X”) divided by the number of pills prescribed by the physician in that same time period, is greater than 80%3,6:
How to measure medication adherence?
The following are some of the approaches that have been used: (1) subjective measurements obtained by asking patients, family members, caregivers, and physicians about the patient's medication use; (2) objective measurements obtained by counting pills, examining pharmacy refill records, or using electronic medication event monitoring systems; and (3) biochemical measurements obtained by adding a nontoxic marker to the medication and detect ing its presence in blood or urine or measurement of serum drug levels . Currently, a combination of these measures is used to assess adherence behavior. Along with the monitoring of outcome, these tools assist investigators in studying medication adherence.
What is the difference between adherence and compliance?
However, their connotations are somewhat different: adherencepresumes the patient's agreement with the recommendations, whereas complianceimplies patient passivity. As described by Steiner and Earnest,5both terms are problematic in describing medication-taking behavior because they “exaggerate the physician's control over the process of taking medications.” The complex issues surrounding the taking of medication for chronic disease cannot easily be distilled into one word. Recognition of this complexity will help avoid assigning blame exclusively to the patient and assist in identifying effective solutions.
What is a recommended course of treatment?
The following by a patient of a recommended course of treatment—e.g., taking all prescribed medications, adhering to a recommended diet and exercise plan and reducing or eliminating alcohol or tobacco intake, and so on.
What is information exchange?
Information exchanges, as well as the delivery of products, are the plurality of stakeholders acting in a network --network-based governance (22) to fill social gaps and help in adherence to treatment. Concerning social support, messages of appreciation for reception in the community, sharing of outbursts and frustrations, invitations to face-to-face meetings, and holiday celebrations were observed (15,19).
Is adherent to treatment universally accepted?
Adherence to treatment does not have an established and universally accepted definition, based on data types, instruments and measurement methods.
What is non-adherence to medical treatment?
The problem of non-adherence to medical treatment remains a challenge for the medical professions and social scientists. Their efforts to explain and improve patient adherence often appear to be ineffective. Although successful adherence interventions do exist [ 1 – 5 ], half of interventions seem to fail [ 6] and adherence theories lack sufficient explaining power. As a result of the widespread problem of adherence, substantial numbers of patients do not get the maximum benefit of medical treatment, resulting in poor health outcomes, lower quality of life and increased health care costs [ 7, 8 ]. In spite of many advances made in adherence research, non-adherence rates have remained nearly unchanged in the last decades [ 9 ].
What is technical adherence?
Technical adherence interventions, for example on dosage and packaging, are usually directed at simplifying the medication regimen. Most adherence interventions in this domain are aimed either at reducing the number of doses per day, for example through extended release formulations, or at reducing the number of different drugs in the regimen, for example by using fixed dose combination pills. Fixed dose combination pills are pills that include two or more drugs in fixed proportions in the same formulation, or blister packaging of several medications in a fixed combination, to be taken together.
What are the findings of Haynes et al.?
They updated their review of 2002 and added 25 recent studies. They came to three conclusions on the basis of 57 un-confounded randomised trials that reported adherence and treatment outcomes with a follow-up period of at least six months. Firstly, less than half (45%) of the interventions resulted in improved adherence and only 33% in better treatment outcomes. Secondly, those interventions that were effective for long-term care were exceedingly complex and labour-intensive. Thirdly, even the most effective interventions did not lead to large improvements in adherence and treatment outcomes [ 6 ].
Which type of social support has the strongest relationship with adherence?
A meta-analysis of 122 studies, conducted by DiMatteo, aimed at assessing which type of social support, either practical, emotional or undifferentiated, has the strongest relationship with adherence [ 52 ]. It appeared that practical social support yielded significantly higher effects than emotional and undifferentiated support. The standardized odds Ratio was 3.60 (2.55–519). There appeared to be a 0.65 SD difference in adherence between patients receiving practical support for their treatment regimen and those not receiving such support. Unfortunately, it is not yet understood how social support contributes to health and which factors moderate and mediate this relationship.
What are behavioral interventions?
The most common behavioural interventions provide patients with memory aids and reminders, whether by mail, telephone, computer, or by home visits. Other classes of interventions consist of monitoring, by means of calendars or diaries, and providing feedback, support or rewards.
What is the focus of a medical review?
The focus of the review is patient adherence to medical treatment – medication, diet, lifestyle changes or appointment keeping – for a diagnosed medical condition prescribed by a health care professional ;
How many systematic reviews of adherence interventions are there?
Significant differences in the effectiveness of adherence interventions were found in 23 of the 38 systematic reviews. Effective interventions were found in each of four theoretical approaches to adherence interventions: technical, behavioural, educational and multi-faceted or complex interventions. Technical solutions, such as a simplification of the regimen, were often found to be effective, although that does not count for every therapeutic regimen.
Abstract
Adherence to treatment, a public health issue, is of particular importance in chronic disease therapies. Primary care practices offer ideal venues for the effective care and management of these conditions. The aim of this study is to assess adherence to treatment and related-factors among patients with chronic conditions in primary care settings.
Background
The increase in life expectancy and the aging of the world population have been paralleled by an alarming growth in the global burden of chronic conditions [ 1 ]. Chronic diseases are generally considered physical or mental conditions that last more than a year and require ongoing care.
Methods
A cross-sectional study was conducted in two primary healthcare centers between August 2016 and March 2017 in Soria, an urban city of 39,000 inhabitants located in the autonomous community of Castile and Leon, Spain.
Results
Among the 344 eligible patients randomly invited to participate in the study, 41 (11.9%) refused to participate and 4 (1.2%) withdrew during the interview process. The characteristics of the excluded subjects were similar to those of the overall group.
Discussion
To our knowledge, this is the first attempt to determine factors associated with adherence under the WHO multidimensional framework in patients with chronic conditions in primary care settings in Spain.
Conclusions
Adherence to long-term treatments for chronic conditions remains a challenging issue in primary care. A low proportion of patients followed the recommendations from healthcare providers which underlines the need of reinforcing medication adherence in primary care. Our results should help to design new interventions aimed to enhance adherence.
Availability of data and materials
Data will be available upon reasonable request from the corresponding author.
LEARNING OBJECTIVES
Describe the relationship between terms used to define medication adherence including persistence, compliance, adherence, and concordance.
INTRODUCTION
Medication nonadherence is a major public health problem. Nearly half of the 187 million people who take medications in the U.S. do not take them as prescribed. Poor medication adherence costs over $100 million annually. Patients with poor adherence to diabetes medication cost the health care system twice as much as patients with high adherence.
PROVIDER MISCONCEPTIONS ABOUT MEDICATION ADHERENCE
There are numerous misconceptions about medication adherence among health care providers. The major misconception is that they “manage” a patient’s chronic disease. In reality, the only time a health care provider manages a chronic disease is the 15 to 30 minutes during periodic follow-up visits.