How does poor adherence to medical treatment affect patient outcomes?
Poor adherence to medical treatment severely compromises patient outcomes and increases patient mortality. According to the WHO, improving adherence to medical therapy for conditions of hypertension, hyperlipidemia, and diabetes would yield very substantial health and economic benefits.
How can we increase medication adherence among patients?
Thus, perhaps the foremost strategy physicians can use to increase medication adherence is to follow a patient-centered approach to care that promotes active patient involvement in the medical decision–making process. As part of such a patient-centered approach, the physician should consider patients' cultural beliefs and attitudes.
What are the top barriers to patient adherence?
According to our survey data, over 75% of practitioners claim that encouraging patient adherence is a key mission within their practice. Through our research, the top barriers to adherence for patients were identified as cost, readiness to change, and feeling overwhelmed.
What drives adherence rates in primary care patients?
Adherence rates have been found to be nearly 3 times higher in primary care relationships characterized by very high levels of trust coupled with physicians' knowledge of the patient as a whole person.
What increases medication adherence?
Successful strategies to improve medication adherence include 1) ensuring access to providers across the continuum of care and implementing team-based care; 2) educating and empowering patients to understand the treatment regimen and its benefits; 3) reducing barriers to obtaining medication, including cost reduction ...
Who factors affecting adherence?
Adherence is a multifactorial problem that can be influenced by various factors. The factors can be roughly divided in the following five dimensions: Social and economic, health care system, health condition, therapy and patient [3].
What is adherence medical treatment?
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 the best predictor of adherence to a care plan?
In meta-analytic work, findings suggest that one of the strongest predictors of patient nonadherence to medical treatment is patient depression (DiMatteo et al 2000).
Which of the following healthcare system barriers can affect patients adherence?
According to the survey, the top 3 physician barriers to patient adherence were unclear communications, lack of time, and a belief that adherence is the patient's responsibility. The top patient barriers were found to be lack of understanding, denial of the severity of their illness, and low health literacy.
Which of the following factors affect patient compliance?
Demographic factors such as age, ethnicity, gender, education, marriage status. Psychosocial factors: beliefs, motivation, attitude. Patient-prescriber relationship. Health literacy.
What can the nurse do to maximize a patient's adherence to the medication regimen?
The following are ten strategies that providers can use to boost medication compliance.Understand each patient's medication-taking behaviors. ... Talk about side effects. ... Write it down. ... Collaborate with patients. ... Consider the financial burden to the patient. ... Assess health literacy. ... Reduce complexity. ... Follow up with patients.More items...•
What is adherence nursing?
Adherence is 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.
Why is medical 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 is adherence monitoring?
Adherence monitoring is an integral part of treating a chronic pain patient. There are several approaches for monitoring a chronic pain patient's adherence to a drug regimen. Simply asking a patient how many pills he or she has left is a traditional, albeit imperfect, method of adherence monitoring.
How can elderly increase medication compliance?
Here are six steps providers should include in their plan.Reduce the number of medications. ... Encourage patients to bring medications to appointments. ... Reduce the number of pharmacies. ... Discuss cost frequently. ... Watch for warning signs. ... Leverage technology to help patients in between appointments.
Which of these personal characteristics is generally the most accurate predictor of patient adherence?
The following disease characteristic is the MOST accurate predictor of patient adherence: severity of the disease as seen by the attending physician.
How does adherence to a treatment regimen affect quality of care?
Quality healthcare outcomes depend upon patients' adherence to recommended treatment regimens. Patient nonadherence can be a pervasive threat to health and wellbeing and carry an appreciable economic burden as well. In some disease conditions, more than 40% of patients sustain significant risks by misunderstanding, forgetting, or ignoring healthcare advice. While no single intervention strategy can improve the adherence of all patients, decades of research studies agree that successful attempts to improve patient adherence depend upon a set of key factors. These include realistic assessment of patients' knowledge and understanding of the regimen, clear and effective communication between health professionals and their patients, and the nurturance of trust in the therapeutic relationship. Patients must be given the opportunity to tell the story of their unique illness experiences. Knowing the patient as a person allows the health professional to understand elements that are crucial to the patient's adherence: beliefs, attitudes, subjective norms, cultural context, social supports, and emotional health challenges, particularly depression. Physician–patient partnerships are essential when choosing amongst various therapeutic options to maximize adherence. Mutual collaboration fosters greater patient satisfaction, reduces the risks of nonadherence, and improves patients' healthcare outcomes.
How to measure adherence to medication?
Adherence needs to be measured using multiple tools. For example, adherence to antidepressant medication might be assessed by pill count, patient self-report, and MEMS (Thompson et al 2000; Hamilton 2003). The combination and reconciling of various assessment techniques can be quite valuable, as individual measures of adherence have been shown to differ from one another by as much as 37% (Milgrom et al 1996).
What are the consequences of nonadherence?
The health consequences of nonadherence can be quite severe. Nonadherence compromises patient outcomes in many different ways but is most obvious when patients fail to take medications that likely would cure or at least effectively manage their illnesses (Miller 1997; Chesney et al 2000; Weir et al 2000). For HIV patients who are not at least 90%–95% adherent, viral replication and consequent disease progression may result (Catz et al 2000; Hinkin et al 2002). For patients suffering from or those at risk of coronary heart disease, nonadherence to medication treatments can jeopardize survival (McDermott 1997). Among diabetic patients, adherence to medication for controlling hypertension is essential to preventing mortality from diabetes and myocardial infarction (Elliott et al 2000). Further, aside from direct biomedical benefits, studies show that health may depend partly upon the act of adhering to a regimen. Some research suggests that adherence, even to a placebo, is itselfbeneficial to health outcomes (McDermott 1997; Irvine et al 1999).
What are the predictors of nonadherence to medical treatment?
In meta-analytic work, findings suggest that one of the strongest predictors of patient nonadherence to medical treatment is patient depression (DiMatteo et al 2000). The risk of patient nonadherence is 27% higher if a medical patient is depressed than if he or she is not (it is 30% higher if that patient has end-stage renal disease). Depression has long been known to predict poor health outcomes, a fact that may be explained partly by the adherence problems caused by depression. Depressed patients experience pessimism, cognitive impairments, and withdrawal from social support, all of which can diminish both the willingness and ability to follow treatment regimens.
What is the corpus of literature on patient adherence?
The corpus of literature on patient adherence is large, and there are many conceptual models that attempt to integrate a large number of complex factors that affect adherence (Bowen et al 2001). To manage the size and complexity of the empirical findings of this massive research enterprise, reliance on meta-analytic work is necessary to provide the building blocks for data-driven models of patient adherence. Currently, ongoing meta-analytic studies at the University of California, Riverside, USA, are beginning to identify a number of stable and consistent factors that affect patient adherence (DiMatteo 2004a, 2004c; DiMatteo et al 2000, 2002). Syntheses of the literature, along with new empirical advances, highlight the complexities inherent in understanding and effecting changes in patient adherence and suggest solutions to common problems in medication management. Much that has been learned from recent research on the communication between healthcare providers and their patients can lessen the economic burden of nonadherence and improve healthcare processes and outcomes for patients.
How many adherence citations are there in PubMed?
The research literature on patient adherence is extensive. Over the past 50 years, there have been 32 550 adherence related citations in PubMed and 10 087 in PsychLit. Of these citations, more than 2000 represent empirical research articles that involved the assessment of medical patients' adherence to a variety of physician-prescribed regimens (medication, diet, exercise, lifestyle changes, etc).
Why does nonadherence go unrecognized in the primary care medical interaction?
Why does such a serious risk factor for nonadherence (and other poor healthcare outcomes) so often go unrecognized in the primary care medical interaction? Research suggests that both patients and their physicians contribute jointly to this problem in the medical interaction. Patient factors that prevent recognition of depression in primary care include lack of awareness and understanding of depression symptoms, complaints of physical symptoms that take precedence or confuse the clinical picture, and failure to admit to psychological symptoms because they fear a stigma of mental illness (Docherty 1997). Patients may be reluctant to talk about non-medical matters because they expect physician disinterest or the risk of embarrassment, or because of anxiety about the possible significance of their psychological symptoms (Roter and Hall 1992).
Why is it important to address patients' beliefs, intentions, and self-efficacy?
This is because knowledge alone is not sufficient to enhance adherence in recommendations involving complex behavior change. [21,22,23]
What is the problem with nonadherence to medication?
The problem of poor adherence to medical treatment is a well-recognized problem in the literature. [1–4]Studies have shown that in the United States alone, nonadherence to medications causes 125,000 deaths annually and accounts for 10% to 25% of hospital and nursing home admissions.[5] This makes nonadherence to medications one of the largest and most expensive disease categories. Moreover, patient nonadherence is not limited to medications alone. It can also take many other forms; these include the failure to keep appointments, to follow recommended dietary or other lifestyle changes, and to follow other aspects of treatment or recommended preventive health practices. Hence, the actual implications of nonadherence go far beyond the financial aspect of medication nonadherence, as estimated above.
How can a clinician optimize behavior change?
Clinicians can optimize behavior change by ensuring that the patients (1) perceive themselves to be at risk due to lack of adoption of healthy behavior (perceived susceptibility), (2) perceive their medical conditions to be serious (perceived severity), (3) believe in the positive effects of the suggested treatment (perceived benefits), (4) have channels to address their fears and concerns (perceived barriers), and (5) perceive themselves as having the requisite skills to perform the healthy behavior (self-efficacy).
How can a physician provide effective patient education?
According to Katz,[20]physicians can provide effective patient education by (1) limiting instructions to 3 or 4 major points during each discussion; (2) using simple, everyday language, especially when explaining diagnosis and giving instructions; (3) supplementing oral teaching with written materials; (4) involving the patient's family members and friends; and (5) reinforcing the concepts discussed.[20] This is especially true for millions of citizens with low literacy skills.
Is understanding of a patient's condition related to adherence?
Research has consistently demonstrated that patients' understanding of their conditions and treatments is positively related to adherence, [15]and that adherence, satisfaction, recall, and understanding are all related to the amount and type of information given. [16]
Do patients always understand prescription instructions?
Many studies have shown that patients do not always understand prescription instructions and often forget considerable portions of what healthcare practitioners tell them. [17,18]Studies have shown that patients who understand the purpose of the prescription are twice more likely to fill it than those who do not understand the purpose. [19]
Why is patient adherence important?
Patient adherence is important for the success of any medical treatment. In a meta-analysis including paediatric and adult populations, DiMatteo et al (5) compared the results of medical treatment in patients who adhered to their treatment with those who did not, and reported a 26% reduction in poor treatment outcome. The odds of a good outcome if the patient is adherent are almost three times higher than the odds if the patient has low adherence (5).
What is adherence in medicine?
The term adherence has been used more in recent literature, and is defined as “the extent to which a person’s behaviour, in terms of taking medications, following diets, or executing lifestyle changes, coincides with medical or health advice” (2).
Why is low adherence important in adolescence?
Health care professionals must be alert to the high prevalence of low adherence to treatment during adolescence. Low adherence increases morbidity and medical complications, contributes to poorer quality of life and an overuse of the health care system. Many different factors have an impact on adherence. However, critical factors ...
How to assess adherence to medication?
Knowledge of the treatment regimen is addressed with questions such as, ‘Can you tell me when you take your medications?’ ‘How many pills do you take?’ The side effects and how the adolescent feels about the treatment are questioned – ‘Does the medication have effects you do not like?’ ‘What do you hate the most?’ This can be followed by questions about difficulties with remembering to take medication and about strategies the teen uses to remember to take his or her medications. The adolescents can be asked to evaluate their own adherence. Three questions can be asked – ‘If 1 represents teens who never take their medication and 5 represents those who always take their medication, where would you see yourself?’ ‘When was the last time you forgot your medications and how often did you forget your medication this past week?’ A significant correlation has been found between these three questions, especially medication forgotten in the two previous days and low overall adherence (50, unpublished data). The adolescents can also be asked whether parents remind them to take their medication; frequent reminders from parents can be a sign of low adherence (50, unpublished data).
What are the consequences of low adherence?
For chronic conditions, low adherence increases morbidity and medical complications (hospitalization), contributes to poorer quality of life (fatigue and school absenteeism) and an overuse ...
What is the difference between adherence and compliance?
Paediatricians and other health care professionals are often faced with adolescents whomtheysuspect may not be following their treatment recommendations. Compliance involves following the doctor’s orders or “the accurate observance by a patient of a prevention or treatment regimen set out by a health professional” (1). The term adherence has been used more in recent literature, and is defined as “the extent to which a person’s behaviour, in terms of taking medications, following diets, or executing lifestyle changes, coincides with medical or health advice” (2). Although compliance and adherence are often used interchangeably, in the present article, adherence is used because it focuses on whether a person adheres to the regimen rather than passively follows the doctor’s orders (3). It also implies partnership and cooperation between the patient and the caregiver.
How does cognitive change affect adolescents?
Cognitive changes include the transition from concrete thinking to more abstract thinking. Young teenagers will mainly believe what they can see or have experienced and, thus, they cannot fully appreciate the long-term or unseen consequences of not taking their medications. Formal operations enable adolescents to deal with hypothetical thinking and to analyze many different kinds of evidence to support an argument. The ability to engage in formal thinking is inconsistent at first, and at times of stress (such as an illness), adolescents may regress to more simple ways of problem solving. Despite their maturing skills, they may remain self-centred and feel invulnerable to consequences –negative things happen only to others. This process explains the risk-taking behaviour and limit testing seen predominantly during adolescence in many domains –sexuality, sports, driving and drug experimentation. Low adherence to treatment can be a way of testing limits. Even adults have difficulty adhering to preventive and health-promoting advices such as diet, exercise, contraception, smoking prevention and helmet use. This is even more of a challenge for adolescents because they often have not yet fully developed risk assessment skills, impulse control or organizational abilities.
What is the barrier to adherence to a treatment plan?
Patients feeling overwhelmed with the treatment plan is another significant barrier to adherence. Treatment plans may contain a long list of supplements or many aspects of the treatment to follow at different times throughout the day. Practitioners commonly report that their patients express feelings of being overwhelmed, ...
What is patient adherence?
Adherence can be defined as the extent to which a patient’s behaviors follow an agreed-upon prescription or therapeutic regimen. ( 1 ) ( 2 ) ( 3) It is similar to “compliance”; however, adherence takes further consideration of the patient’s views and choices, and it allows them to play a more active role in the development of the treatment plan.
What are the barriers to adherence for Fullscript?
Fullscript practitioners have reported cost, readiness to change, and feeling overwhelmed as the top barriers to adherence for patients.
What is a resource for patients?
Resources for patients are intended to be educational and do not replace the relationship between health practitioners and patients. In all content, we clearly recommend that readers refer back to their healthcare practitioners for all health-related questions.
What are the dimensions of adherence?
The World Health Organization’s (WHO) 2003 report on adherence describes five interacting dimensions that influence adherence to treatment plans within states of chronic disease, which include condition/disease, patient, social and economic, systemic and healthcare team, and therapeutic factors. ( 3)
Is non-adherence a patient centered problem?
Despite the many contributing factors, non-adherence has been traditionally considered a patient-centered problem. Therefore, interventions to improve adherence have primarily focused on patient factors and have largely ignored the other dimensions. ( 9 ) ( 10 ) ( 16 ) ( 17)
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