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
Open this folder and view contentsChapter XIV - Tobacco smoking cessation
Close this folderChapter XV - Tuberculosis
View the document1. Definition of adherence
View the document2. Factors that influence adherence to treatment
View the document3. Prediction of adherence
View the document4. Strategies to improve adherence to treatment
View the document5. Questions for future research
View the document6. References
Open this folder and view contentsAnnexes
Open this folder and view contentsWhere to find a copy of this book
 

1. Definition of adherence

In terms of TB control, adherence to treatment may be defined as the extent to which the patient's history of therapeutic drug-taking coincides with the prescribed treatment (7).

Adherence may be measured using either process-oriented or outcome-oriented definitions. Outcome-oriented definitions use the end-result of treatment, e.g. cure rate, as an indicator of success. Process-oriented indicators make use of intermediate variables such as appointment-keeping or pill counts to measure adherence (7). The extent to which these intermediate outcomes correlate with the actual quantities of prescribed drugs taken is unknown (8).

The point that separates "adherence" from "nonadherence" would be defined as that in the natural history of the disease making the desired therapeutic outcome likely (adherence) or unlikely (nonadherence) to be achieved. There is as yet no empirical rationale for a definition of nonadherence in the management of TB. Therefore, the definition of adherence to TB treatment needs to be translated into an empirical method of monitoring both the quantity and timing of the medication taken by the patient (9). At the individual level this is desirable, but at the population level a more pragmatic approach is needed. Thus, the success of treatment, that is, the sum of the patients who are cured and those who have completed treatment under the directly observed therapy, short course (DOTS) strategy, is a pragmatic, albeit a proxy, indicator of treatment adherence.

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