Definitions
Treatment adherence refers to the extent to which a person’s behavior conforms to the agreed-upon recommendations of a health care professional or therapist. So, for example, with regard to taking medications, following a diet, or adhering to lifestyle changes. The English terms adherence and compliance are often used. Today, the term adherence is in the foreground because it presupposes that the patient has agreed to the prescribed therapy in a relationship of partnership (concordance). The opposite of good adherence to therapy is also referred to as nonadherence or noncompliance.
Frequency
Unfortunately, it is far from the case that patients strictly take their physicians’ recommendations to heart. Adherence to therapy is often overestimated. For example, it is reported that in the United States, only one in two hypertensive patients takes their medications as prescribed. The same figure is said to apply to schizophrenic patients. Adherence to treatment for chronic diseases is only about 50 to 60%. Naturally, very different values are found in the literature, which also depend on the field of application.
Follow
Most drug therapies require regular administration of the drug. This is because the active pharmaceutical ingredients contained in them usually have a short duration of action, ranging from a few hours to a few days. Drugs are often administered once to three times a day. Once the active ingredient is eliminated from the body, it no longer exerts any effect. If this regimen is deviated from to a greater or lesser extent, the efficacy also decreases and the desired therapeutic effect is diminished or fails to occur altogether. This can have devastating consequences: A blood clot develops and leads to a heart attack, a young girl becomes pregnant unintentionally, an epileptic has a seizure and falls, or a diabetic falls into a coma. Non-adherence also has significant economic consequences because therapies have to be changed or patients have to be hospitalized. These costs are actually unnecessary and avoidable.
Causes
There are many reasons why patients do not comply with recommended measures and do not take their medications according to the necessary regimens. Factors that promote nonadherence include: Individual factors:
- Perceptions and attitudes of the patient, language barriers.
- Personality, low motivation, addictive behavior (e.g. smoking, alcohol, sweets).
- Age, diseases, disabilities, forgetfulness.
- Practical problems with the administration
- Low social support
- Low socioeconomic status
Therapy-related factors:
- Adverse effects, lack of efficacy.
- Lack of understanding
- Complex dosage and application
- Polypharmacy
Health care system:
- Doctor-patient relationship, lack of trust.
- Insufficient communication
- Lack of health insurance, high deductible
Measures to improve adherence to treatment
The possible measures to promote adherence to therapy are as varied as the causes. These include:
- Comprehensive discussion of medication, e.g., intake, background, and duration of therapy.
- Open discussions between patient and medicine person on adherence to therapy (e.g. polymedication check).
- Close-meshed support, aftercare offer, monitoring.
- Aids and reminders, e.g. dosing systems, apps, SMS messages, telephone messages, diaries.
- Simplification of the treatment plan, e.g., use of a contraceptive ring instead of oral contraceptives.
- Change of drugs that are not tolerated
- Use generic drugs to reduce costs