Assessing patient adherence to chronic diseases treatment: differentiating between epidemiological and clinical approaches

Abstract

This review discusses the concepts and methods for assessing patient adherence to treatment, as applied to both epidemiological and clinical approaches within real health care practices. For the epidemiological approach, the assessment must be as accurate as possible. Self-reported questionnaires are the most feasible option in most circumstances, but most demonstrate low sensitivity combined with high specificity. We suggest that self-reported outcomes, where feasible, can increase the sensitivity for non-adherence of these questionnaires. In the clinical approach an accurate distinction between adherents and non-adherents is less useful. For the health provider, it is more important to be aware of the particular situation that each patient is currently experiencing with his/her treatment. Self-reported questionnaires applied in clinical settings can help the health provider to form an objective opinion. In any event, the patient-provider dialogue is still the best approach to assess patient adherence as well as to deliver good care.

Factors affecting medication adherence among patients with rheumatic disorders

“…[10] Nemes, Helena, Caraciolo and Basso (2009) commented that good outcomes from chronic diseases largely depend on the degree of medication's adherence. [8] Also, many authors commented that co-morbid diseases requiring that patients take a number of medications, which can negatively affect medication's adherence. [31,32] For investigating therapy related dimensions such as treatment interferes with lifestyle or requires significant behavioral changes, actual or perceived unpleasant side effects, duration of therapy, complexity of medication regimen and frequent changes in medication regimen, the present study showed that these were the most consistently notified factors affecting on medication adherence.…”

“…The notion of adherence proposes an alliance relationship, whereby therapeutic guidance should be agreed upon between patient and health care providers, thus recognizing partial autonomy of the patient or an active role in collaboration with a prescriber with regard to how treatment is followed. [4,8,12] Non-adherence refers to discontinuation or failure of proper medication intake without prior approval from the treating health-care providers. Also, "non-adherence" encompasses the diverse factors for patients not following a treatment recommendation.…”

“…Several studies have shown that a few degree of non-adherence occurs globally, among developed as well as undeveloped countries and is even seen in life-threatening illness. [7,8] Non-adherence ratio is typically higher among patients with chronic diseases such as cardiovascular diseases, hypertension and depression as compared to those with acute conditions. [9,10] In 2003, the World Health Organization (WHO) pointed out that adherence to therapeutic regimen is multidimensional phenomenon determined by interaction of five groups of factors; termed "dimensions".…”

Adesão ao Tratamento em Gestação de Alto Risco

“…Bons resultados, ou seja, gravidez e parto com o mínimo de intercorrências, dependem de uma alta adesão ao seguimento do plano terapêutico (Nemes et al, 2009). …”

Avaliação da efetividade de uma intervenção psicossocial para melhorar a adesão do paciente à terapia antirretroviral da Aids: ensaio controlado aleatório utilizando monitoramento eletrônico

“…Estes estudos distinguem os indivíduos em aderentes ou não aderentes de acordo com pontos de corte estabelecidos por comparação entre estudos e por aqueles que correlacionam adesão e resultados clínicos. 21 A maioria dos estudos observacionais atuais sobre adesão à TARV considera aderentes os indivíduos que tomam 95% ou mais das doses prescritas. Este "nível de corte" passou a ser tomado como referência a partir de 2000 com o estudo de Patterson et al 22 que mostrou que a partir deste nível de adesão a carga viral do HIV torna-se indetectável, isto é, abaixo de 400 cópias/ml de sangue, em pacientes em uso dos esquemas de antirretrovirais da classe dos inibidores da protease disponíveis na época.…”