Improving Adherence to Treatment for Chronic Diseases
Chronic diseases are long-term conditions that affect the quality of life and well-being of millions of people around the world. Examples of chronic diseases include diabetes, hypertension, asthma, arthritis, and heart disease. According to the World Health Organization (WHO), chronic diseases are responsible for 71% of all deaths globally and 88% of all deaths in Europe .
One of the main challenges in managing chronic diseases is ensuring that patients adhere to their prescribed treatment plans. Adherence is 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” . Poor adherence can lead to worse health outcomes, increased complications, reduced quality of life, and higher health care costs .
Therefore, improving adherence to treatment for chronic diseases is a crucial goal for health care professionals, policy makers, and researchers. In this blog post, we will discuss some of the factors that influence adherence, some of the strategies that can enhance adherence, and some of the benefits that can result from improved adherence.
Factors that influence adherence
Adherence to treatment for chronic diseases is influenced by a complex interplay of factors related to the patient, the health care provider, the health care system, the disease, and the treatment . Some of these factors are:
– Patient-related factors: These include the patient’s knowledge, beliefs, attitudes, motivation, self-efficacy, expectations, preferences, social support, and coping skills. For example, a patient who understands the benefits and risks of their treatment, who trusts their health care provider, who feels confident in their ability to manage their condition, and who has supportive family and friends is more likely to adhere to their treatment than a patient who lacks these factors.
– Health care provider-related factors: These include the provider’s communication skills, empathy, rapport, trustworthiness, competence, availability, and feedback. For example, a provider who communicates clearly and respectfully with the patient, who listens to their concerns and preferences, who provides adequate information and education, and who monitors and reinforces their progress is more likely to foster adherence than a provider who does not.
– Health care system-related factors: These include the accessibility, affordability, convenience, coordination, and quality of health care services. For example, a health care system that offers easy access to care, low-cost or subsidized medications and devices, convenient appointment times and locations, integrated and multidisciplinary care teams, and high standards of care is more likely to facilitate adherence than a system that does not.
– Disease-related factors: These include the severity, duration, complexity, symptoms, and prognosis of the disease. For example, a disease that causes severe pain or discomfort,
that lasts for a long time or requires lifelong management,
that involves multiple or complicated regimens,
that produces noticeable or bothersome symptoms,
or that has a poor or uncertain outlook is more likely to impair adherence than a disease that does not.
– Treatment-related factors: These include the effectiveness,
safety,
simplicity,
convenience,
and cost of the treatment. For example,
a treatment that works well,
that has few or mild side effects,
that requires few or simple doses or steps,
that fits well with the patient’s lifestyle and schedule,
and that is affordable or covered by insurance is more likely to enhance adherence than a treatment that does not.
Strategies that can enhance adherence
Given the multiple and interrelated factors that influence adherence,
there is no single or simple solution to improve it.
Rather,
a combination of tailored and evidence-based strategies that address the specific barriers and facilitators of each patient is needed .
Some of these strategies are:
– Patient education: This involves providing clear,
accurate,
and relevant information about the disease and the treatment to the patient in a way that they can understand and apply. Patient education can help increase the patient’s knowledge,
awareness,
and motivation to adhere to their treatment plan.
– Behavioural interventions: These involve using techniques such as goal setting,
self-monitoring,
feedback,
reminders,
rewards,
and problem-solving to help the patient change their behaviour and habits related to their treatment. Behavioural interventions can help enhance the patient’s self-efficacy,
accountability,
and satisfaction with their treatment outcomes.
– Cognitive interventions: These involve using methods such as cognitive restructuring,
motivational interviewing,
and shared decision making to help the patient modify their beliefs,
attitudes,
and expectations related to their disease and treatment. Cognitive interventions can help reduce the patient’s resistance,
ambivalence,
and misconceptions about their treatment plan.
– Social interventions: These involve involving family members,
friends,
peers,
or other support persons in the patient’s care process. Social interventions can help provide emotional,
practical,
and informational support to the patient and reinforce their adherence behaviour.
– Health care provider interventions: These involve improving the communication,
relationship,
and collaboration between the health care provider and the patient. Health care provider interventions can help establish trust,
rapport,
and partnership with the patient and tailor the treatment plan to their needs and preferences.
– Health care system interventions: These involve modifying the structure,
organization,
and delivery of health care services to make them more accessible,
affordable,
convenient,
coordinated,
and quality-oriented. Health care system interventions can help reduce the barriers and enhance the facilitators of adherence at the system level.
Benefits that can result from improved adherence
Improving adherence to treatment for chronic diseases can have significant benefits for the patient,
the health care provider,
the health care system,
and the society .
Some of these benefits are:
– For the patient: Improved adherence can lead to better health outcomes,
such as reduced symptoms,
complications,
hospitalizations,
and mortality. It can also lead to improved quality of life,
such as increased physical,
mental,
and social well-being. It can also lead to reduced health care costs,
such as lower medication and device expenses,
co-payments,
and out-of-pocket fees.
– For the health care provider: Improved adherence can lead to enhanced professional satisfaction,
such as increased confidence,
competence,
and recognition. It can also lead to improved clinical performance,
such as higher quality of care,
efficiency,
and effectiveness. It can also lead to reduced workload and stress,
such as lower demand for consultations,
follow-ups,
and interventions.
– For the health care system: Improved adherence can lead to improved system performance,
such as lower health care utilization and expenditure, higher cost-effectiveness and return on investment, and better population health and equity. It can also lead to improved system reputation, such as higher patient satisfaction, loyalty, and trust, and better public perception and accountability.
– For the society: Improved adherence can lead to improved social outcomes, such as lower disease burden and disability, higher productivity and economic growth, and better social cohesion and justice.
Conclusion
Improving adherence to treatment for chronic diseases is a complex but important challenge that requires a multifaceted and individualized approach. By understanding the factors that influence adherence, implementing the strategies that can enhance adherence, and realizing the benefits that can result from improved adherence, we can make a positive difference in the lives of millions of people living with chronic diseases.
References
: WHO (2021). Noncommunicable diseases. Retrieved from https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
: WHO (2003). Adherence to long-term therapies: evidence for action. Retrieved from https://www.who.int/chp/knowledge/publications/adherence_report/en/
: DiMatteo, M.R. (2004). Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Medical Care, 42(3), 200-209.
: Haynes, R.B., Ackloo, E., Sahota, N., McDonald, H.P., & Yao, X. (2008). Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews, (2), CD000011.
: Nieuwlaat, R., Wilczynski, N., Navarro, T., Hobson, N., Jeffery, R., Keepanasseril, A., Agoritsas, T., Mistry, N., Iorio, A., Jack, S., Sivaramalingam, B., Iserman, E., Mustafa, R.A., Jedraszewski, D., Cotoi, C., & Haynes R.B. (2014). Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews, (11), CD000011.
: Cutler D.M., Everett W. (2010). Thinking outside the pillbox — medication adherence as a priority for health care reform. New England Journal of Medicine, 362(17), 1553-1555.
