Supporting Adherence to Medicines for Long-Term Conditions

Abstract

Abstract. Pharmaceutical prescriptions are core to the treatment of most chronic illnesses, yet only half are taken as prescribed. Despite the high costs of nonadherence to individuals and society, effective adherence-promoting interventions are elusive. This is partly due to the sheer complicity of the issue. There are numerous determinants of adherence, both internal to the patient (intrinsic) and external (extrinsic, e.g., environmental or health system-related factors). Also, the relative importance of these determinants varies between individuals and even within the same individual over time and across treatments, presenting a challenge for intervention design. One complication is that interventions can target several levels: (1) patient (e.g., enhancing motivation and/or ability to adhere), (2) patient-provider interactions (e.g., improving communication and the prescribing process), and (3) the healthcare system (e.g., providing the opportunity to access medication through regulatory approval and co-payment schemes). Here, we focus on level 1: the patient. Although environmental factors are important, the effect of an intervention designed to change them will depend on how they impact on the individual. We describe the Perceptions and Practicalities Approach (PAPA), a pragmatic framework positing that adherence/nonadherence is essentially a produce of individual motivation and ability. Adherence interventions, targeted at any level, will therefore be more effective if tailored to address the perceptions and practicalities underpinning individual motivation and ability. We discuss how PAPA can be operationalized, including the application of theoretical models of illness and treatment representation (Necessity-Concerns Framework and Leventhal’s Common-Sense Model) to address salient adherence-related perceptions.

Practical Barriers to Medication Adherence: What Do Current Self- or Observer-Reported Instruments Assess?

“…Yet, much of the literature focuses either on the measurement of adherence itself, or on perceptual barriers, or both, with few focusing on the practical issues influencing adherence. Whilst it is important to target both perceptual and practical barriers (Linn et al, 2013), and there is often an overlap between these (Horne et al, 2019), practical barriers represent a good starting point for improving adherence. Practical barriers are generally more easily overcome by simple interventions (e.g., changes to the physical environment or medication regimen) (Horne et al, 2019) and may be useful as an initial adherence intervention.…”

“…Whilst it is important to target both perceptual and practical barriers (Linn et al, 2013), and there is often an overlap between these (Horne et al, 2019), practical barriers represent a good starting point for improving adherence. Practical barriers are generally more easily overcome by simple interventions (e.g., changes to the physical environment or medication regimen) (Horne et al, 2019) and may be useful as an initial adherence intervention. Identifying practical barriers may allow health professionals to make simple interventions to improve adherence first before trialling more resource-intensive interventions to shift perceptual barriers.…”

“…These factors can be enablers or barriers to adherence and broadly classified as either perceptual or practical, an approach which has been described in The National Institutes of Clinical Excellence (NICE) adherence guidelines (Horne et al, 2005;Nunes et al, 2009). Perceptual factors refer to factors which arise primarily from internal cognitive processes, such as motivation, emotions, or patient perceptions and beliefs of the illness and treatment, while practical factors refer primarily to external environmental factors relating to the individual, treatment, or society which can affect behaviour (Horne et al, 2019). Examples include the look and feel of the medication, how easy it is to access the medication, and the structure of the healthcare system.…”

Best Practices and Recommendations for Digital Interventions to Improve Engagement and Adherence in Chronic Illness Sufferers

“…The opportunity to expand the study about the influence of e-health literacy for adjustment and self-management may also contribute to explore barriers which in turn may endorse a more pragmatic approach to adherence in chronic conditions. In that sense, Horne, Cooper, Wileman, and Yan Chan (2019) contribution to this special issue outline the key features of the Perceptions and Practicalities Approach as a framework to address how the understanding of the illness and treatment impacts on the patient's motivation and ability to follow the agreed treatment recommendations. This contribution gives further support to the patient-centered approach, and how the patient' resources may contribute to tailor interventions and promote better adjustment in chronic conditions.…”

Psychosocial aspects and contributions of behavioural science to medication‐taking for adults with type 2 diabetes

“…Expanding on our prior theoretical understanding of illness perceptions and beliefs about medications, Horne et al propose a new framework, the Perceptions and Practicalities Approach, for developing interventions to support optimal treatment decisions and medication‐taking behaviours. They discuss how the framework can be operationalized, including the application of the Necessity–Concerns Framework, to address salient psychosocial barriers to medication use.…”