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
Open this folder and view contentsSection II - Improving adherence rates: guidance for countries
Close this folderSection III - Disease-Specific Reviews
Open this folder and view contentsChapter VII - Asthma
Close this folderChapter VIII - Cancer (Palliative care)
View the document1. Definitions and epidemiology of adherence
View the document2. Factors and interventions affecting adherence
View the document3. Conclusions
View the document4. References
Open this folder and view contentsChapter IX - Depression
Open this folder and view contentsChapter X - Diabetes
Open this folder and view contentsChapter XI - Epilepsy
Open this folder and view contentsChapter XII - Human immunodeficiency virus and acquired immunodeficiency syndrome
Open this folder and view contentsChapter XIII - Hypertension
Open this folder and view contentsChapter XIV - Tobacco smoking cessation
Open this folder and view contentsChapter XV - Tuberculosis
Open this folder and view contentsAnnexes
Open this folder and view contentsWhere to find a copy of this book
 

1. Definitions and epidemiology of adherence

Published studies were considered for inclusion here if they reported relevant epidemiological or economic data on adherence to one of the therapies usually used in palliative care. A search on adherence to cancer palliative care was made using Medline (1990 - 2002). Some reviews and reports from international and national organizations were also included. The search retrieved only studies that evaluated adherence to pain relief in palliative care.

Adherence was usually not explicitly defined in the articles retrieved, but referred to generally as "patients following medical recommendations". In operational terms, the variables of adherence were defined as: "not filling a prescription", "not taking medication", "errors in dosage", "reducing medication", "taking extra medication" and "taking additional nonprescribed medication" (6,7,9,10).

The studies reviewed here used several different methods to estimate the adherence of patients to their medication. These methods, which can be used either separately or in combination, include review of medical records, patient self-report, family report, residual pill counting, electronic measurement devices, prescription refill rates, biological markers in serum or urine, assays to quantify medications or their metabolites and therapeutic outcome (6,9).

Few studies have provided data on the level of adherence of oncology patients to their pain relief, and the methods used to calculate adherence rates were not always described. Zeppetella et al., reported that 40% of patients with cancer adhered to pain relief drugs (9). Miaskowski et al. reported adherence rates for opioid analgesics. Cancer patients prescribed relief on an around-the-clock basis took an average of 88.9%, whereas those who were prescribed relief on an as-needed basis had an adherence rate of about 24.7% (6). Du Pen et al. reported that adherence of oncology patients to their prescribed opioid therapy was between 62% and 72% (7) and Ferrell et al. reported a mean adherence rate of 80% (10).

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