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
Open this folder and view contentsChapter VIII - Cancer (Palliative care)
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
Close this folderChapter XIV - Tobacco smoking cessation
View the document1. The burden of tobacco smoking
View the document2. Clinical guidelines and therapies available for tobacco smoking cessation
View the document3. Definitions
View the document4. Epidemiology of adherence
View the document5. Factors affecting adherence
View the document6. Interventions for improving adherence
View the document7. Cost, effectiveness and cost-effectiveness of adherence
View the document8. Conclusions
View the document9. References
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

6. Interventions for improving adherence

The most frequently employed interventions for improving adherence reviewed were NRT, antidepressant therapy, pharmacist intervention, psychosocial/behavioural support and counselling, and diet counselling (low-calorie diet) (see also Table 9). Adjunctive psychosocial treatment or behavioural advice has been successfully used to support smoking cessation programmes (25).

Although Alterman et al. showed that patients receiving more intense adjunctive psychosocial or medical treatment were more adherent to treatment with patches (25), overall, the data reviewed suggested that minimal behavioural support also results in similar or higher adherence rates, at least for some types of smoker. Minimal behavioural support might offer a cost-effective way to implement first-line smoking cessation programmes at a population level. More controlled studies including cost-effectiveness analysis are needed to clarify this issue.

The monitoring of therapeutic drug levels, NRT and/or antidepressant may also be useful. This feedback might be used to identify poorly adherent patients for whom more intensive adherence-enhancing interventions would be helpful (46).

Intensive anti-smoking campaigns, such as the "Truth Denormalization Ads" might be extremely useful, especially among teenagers, as they change the social attitude towards tobacco smoking.

Table 9 Factors affecting adherence to smoking cessation therapy and interventions for improving it, listed by the five dimensions and the interventions used to improve adherence

Tobacco smoking

Factors affecting adherence

Interventions to improve adherence

Socioeconomic-related factors

(-) High treatment cost (41)

(+) Higher education levels, older age (41)

Social assistance (25)

Health care team/health system-related factors

(-) Unavailability for follow up or lost to follow up (1,8,10,11,17,21); failure to recall the receipt of a prescription (20)

(+) Access to free NRT; more frequent contact with physicians and pharmacists (35)

Pharmacist mobilization (41); access to free NRT; frequent follow-up interviews (35)

Condition-related factors

(-) Daily cigarette consumption; expired CO, plasma nicotine and cotinine levels; Fagerstrom Tolerance Questionnaire (FTQ) scores (44); greater tobacco dependence (25); psychiatric comorbidities; depression (3,25); failure to stop or reduce smoking during treatment (1,3,8 - 10,17,18,21,22,24,29,36 - 38,41 - 43)

Education on use of medications; supportive psychiatric consultation (3,25)

Therapy-related factors

(+) Attendance at behavioural intervention sessions (26); adverse events (1,9,16,37 - 40) or withdrawal symptoms (1,9,11,12,13,16 - 18,22,35 - 40)

NRT; antidepressant therapy; education on use of medications; adherence education; assistance with weight reduction (29); continuous monitoring and reassessment of treatment; monitoring adherence (46)

Patient-related factors

(-) Weight gain (29)

(+) Motivation (25); good relationship between patient and physician (41)

Adjunctive psychosocial treatment; behavioural intervention (1,9 - 13,16 - 19,21 - 23,25,29,30,32,38,39,47 - 52); assistance with weight reduction (29); good patient - physician relationship (41)


CO, Carbon monoxide; NRT, nicotine replacement therapy; (+) factors having a positive effect on adherence; (-) factors having a negative effect on adherence.

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