Term “treatment adherence”
Adherence to medical prescriptions is the most important component of treatment programs, and its absence is regarded as an independent risk factor for hospitalizations, an unfavorable prognosis and unplanned financial costs.
There are several terms that define the degree of patient compliance with prescribed treatment, including such concepts as “adherence”, “compliance” and “continuity of treatment” (persistence). In 1979, R. Haynes et al. defined compliance as adherence of a patient (in relation to taking medications, following dietary guidelines or lifestyle changes) to medical care or recommendations.
Adherence to treatment is the degree of compliance of the patient’s behavior with doctor’s recommendations in relation to both the regularity of admission and the prescribed dosage of medications, treatment regimen; adherence is considered exclusively within the framework of doctor-patient cooperation.
There are two main components of treatment adherence:
- duration of medication administration (the period from initiation to the termination of treatment);
- compliance (comparison of the prescribed regimen with the true intake), including skipping the dose (fig. 11.1).
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Fig. 11.1. Treatment retention and adherence to treatment
Factors that affect patient’s adherence to treatment
Treatment adherence is a multicomponent phenomenon determined by the disease, patient, doctor, healthcare system as a whole, social/economic factors and treatment (fig. 11.2).
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Fig. 11.2. Components of treatment adherence
Awareness of the disease, level of education, microsocial environment, patient’s reaction to doctor’s vocabulary, and many others affect adherence to treatment. All these factors are important, and it is impossible to single out the most significant one that determines human behavior.
Risk factors for low adherence associated with the disease
Patients’ adherence to treatment for different diseases may differ significantly. Long-term diseases require long-term medication, as well as compliance with lifestyle restrictions, which is not performed by every patient.
With a long course of the disease and its complications, irreversible changes develop in the target organs, which do not allow the patient to feel the instant effect of medications. Regime violation or low discipline also do not allow achieving a rapid therapy effect, which does not motivate patients to take medications constantly.
Sometimes, patients deliberately skip the dose, while receiving treatment for concomitant diseases, as they are afraid of unfavorable outcome due to drug interactions.
Multimorbidity is closely related to polypragmasy (“poly” — a lot and “pragma” — an object, a thing), and prescription of a large number of drugs for a long period of time, in most cases, increases the risk of undesirable interactions and reduces the response to treatment.
Risk factors for low adherence associated with the patient
The problem of treatment adherence is multidisciplinary, and various attitudes of patients to treatment are often associated with the characteristics of the patient himself, and not with the nature of the disease.
Adherence is influenced by patient’s gender and age. Female patients are more committed to longer-term treatment than male. People below the retirement age are more committed to doctor’s recommendations and comply with them more regularly than older people.
The patient’s willingness to follow the health care professional’s recommendations is directly linked to health improvement due to medication intake.
Imperception of the disease, loneliness, stress, low level of economic status and education, lack of knowledge about the disease, low level of integrative intelligence, internal conflict are factors of low adherence to long-term treatment.
The factors associated with patients can be conditionally divided into unintentional and intentional (table 11.1).
Table 11.1. Types of non-adherence to treatment
| Unintentional | Intentional |
Forgetfulness.
Inattention.
Mental illnesses.
Restrictions related to working conditions.
Misunderstanding of the doctor’s recommendations (language barrier, complex treatment regimen) | Fear of side effects.
High cost of treatment.
Lack of faith in treatment.
Fear that the drugs are dangerous for the body.
Unwillingness to be treated.
No obvious benefit.
The need for “medication holidays” |
An important factor affecting the adherence to long-term treatment, especially for a patient who is not being observed in the outpatient setting, is the patient’s satisfaction with treatment.
Social aspects play a significant part in low adherence: a change in financial situation, moving to a new place of residence, high treatment costs, appearance of concomitant diseases that require additional treatment.
Risk factors for low adherence associated with a doctor
A trusting and friendly relationship between the patient and the attending physician can help overcome significant obstacles in non-adherence to treatment. Doctor’s adherence to the principles of rational therapy helps to increase patient’s adherence to treatment.
Risk factors for low adherence associated with treatment
Complex regimen and duration of treatment, high cost of drugs, side effects of treatment reduce adherence.