Adherence to Long-Term Therapies - Evidence for Action
(2003; 211 pages) View the PDF document
Table of Contents
View the documentPreface
View the documentAcknowledgements
View the documentScientific writers
View the documentIntroduction
View the documentTake-home messages
Open this folder and view contentsSection I - Setting the scene
Close this folderSection II - Improving adherence rates: guidance for countries
Close this folderChapter IV - Lessons learned
View the document1. Patients need to be supported, not blamed
View the document2. The consequences of poor adherence to long-term therapies are poor health outcomes and increased health care costs
View the document3. Improving adherence also enhances patient safety
View the document4. Adherence is an important modifier of health system effectiveness
View the document5. Improving adherence might be the best investment for tackling chronic conditions effectively
View the document6. Health systems must evolve to meet new challenges
View the document7. A multidisciplinary approach towards adherence is needed
View the document8. References
Open this folder and view contentsChapter V - Towards the solution
Open this folder and view contentsChapter VI - How can improved adherence be translated into health and economic benefits?
Open this folder and view contentsSection III - Disease-Specific Reviews
Open this folder and view contentsAnnexes
Open this folder and view contentsWhere to find a copy of this book

1. Patients need to be supported, not blamed

Despite evidence to the contrary, there continues to be a tendency to focus on patient-related factors as the causes of problems with adherence, to the relative neglect of provider and health system-related determinants. These latter factors make up the health care environment in which patients receive care and have a considerable effect on adherence. Interventions that target the relevant factors in the health care environment are urgently required.

Patients may also become frustrated if their preferences in treatment-related decisions are not elicited and taken into account. For example, patients who felt less empowered in relation to treatment decisions had more negative attitudes towards prescribed antiretroviral therapy and reported lower rates of adherence (1).

Adherence is related to the way in which individuals judge personal need for a medication relative to their concerns about its potential adverse effects (2). Horne et al. proposed a simple necessity-concerns framework to help clinicians elicit and address some of the key beliefs that influence patients' adherence to medication. Necessity beliefs and concerns are evaluative summations of the personal salience of the potential costs and benefits or pros and cons of the treatment (3).

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