Adherence
Adherence = extent to which the patient’s behaviour matches
agreed recommendations from the prescriber
Why is it important to study adherence?
- We have an ageing population, with many different illnesses and prescriptions
- To aim to reduce the number of non-working people in the population due
to an illness, currently at 7.5% of UK population (work can increase QoL and
mental health)
- Non-adherence is very common 30-50% across different populations
(DiMatteo, 2002, 2004)
- Non-adherence has large outcomes for not only the individual (disability, QoL,
independence, death) but societally (NHS costs, discrimination, taxpayer costs)
- DiMatteo et al., 2002 reviewed 63 studies on the relationship between
adherence and medical outcomes and found that the odds of good
outcomes were 3x higher among high adherers.
- Simpson et al., 2006 reviewed 21 studies and found the odds of mortality
among those with high adherence was half of those with low adherence
(but also found similar pattern when adhering to placebo? Psychological effect on
health outcomes?)
TREATMENT ADHERENCE 1
, - What does the model mean by discontinuing?
- What is the length of time required to be labelled as discontinued?
- Is it still non-adherence if the patient switches treatment?
- Is it still non-adherence if they never collect their prescription?
Intervention Reviews
- Peterson et al., 2003 reviewed 95 RCTs of interventions and found the
increase in adherence was 4-11%.
- Haynes et al., 2008 a review of 81 interventions found that less than half were
associated with improved adherence, and less than 1/3 were associated with
improved clinical outcomes.
- Design: limitations not tailored enough, not very specific
- Development: content not specified in enough detail, studies do not pinpoint
the causes of non-adherence or barriers etc
TREATMENT ADHERENCE 2
Adherence = extent to which the patient’s behaviour matches
agreed recommendations from the prescriber
Why is it important to study adherence?
- We have an ageing population, with many different illnesses and prescriptions
- To aim to reduce the number of non-working people in the population due
to an illness, currently at 7.5% of UK population (work can increase QoL and
mental health)
- Non-adherence is very common 30-50% across different populations
(DiMatteo, 2002, 2004)
- Non-adherence has large outcomes for not only the individual (disability, QoL,
independence, death) but societally (NHS costs, discrimination, taxpayer costs)
- DiMatteo et al., 2002 reviewed 63 studies on the relationship between
adherence and medical outcomes and found that the odds of good
outcomes were 3x higher among high adherers.
- Simpson et al., 2006 reviewed 21 studies and found the odds of mortality
among those with high adherence was half of those with low adherence
(but also found similar pattern when adhering to placebo? Psychological effect on
health outcomes?)
TREATMENT ADHERENCE 1
, - What does the model mean by discontinuing?
- What is the length of time required to be labelled as discontinued?
- Is it still non-adherence if the patient switches treatment?
- Is it still non-adherence if they never collect their prescription?
Intervention Reviews
- Peterson et al., 2003 reviewed 95 RCTs of interventions and found the
increase in adherence was 4-11%.
- Haynes et al., 2008 a review of 81 interventions found that less than half were
associated with improved adherence, and less than 1/3 were associated with
improved clinical outcomes.
- Design: limitations not tailored enough, not very specific
- Development: content not specified in enough detail, studies do not pinpoint
the causes of non-adherence or barriers etc
TREATMENT ADHERENCE 2
