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
Open this folder and view contentsSection III - Disease-Specific Reviews
Close this folderAnnexes
Open this folder and view contentsAnnex I - Behavioural mechanisms explaining adherence
Open this folder and view contentsAnnex II - Statements by stakeholders
View the documentAnnex III - Table of reported factors by condition and dimension
View the documentAnnex IV - Table of reported interventions by condition and dimension
Open this folder and view contentsAnnex V - Global Adherence Interdisciplinary Network (GAIN)
Open this folder and view contentsWhere to find a copy of this book
 

Annex III - Table of reported factors by condition and dimension

 

Socioeconomic-related factors

Health care team/health system-related factors

Condition-related factors

Therapy-related factors

Patient-related factors

Asthma

(-) Vulnerability of the adolescent to not taking medications; family conflict and a denial of severity of disease in adolescents; memory difficulties in older patients; polypharmacy in older patients; cultural and lay beliefs about illness and treatment; alternative medicine; fear of the health care system; poverty; inner-city living; lack of transport; family dysfunction

(-) Health care providers' lack of knowledge and training in treatment management and/or an inadequate understanding of the disease; short consultations; lack of training in changing behaviours of nonadherent patients

(-) Inadequate understanding of the disease

(-) Complex treatment regimens; long duration of therapy; frequent doses; adverse effects of treatment

(-) Forgetfulness; misunderstanding of instructions about medications; poor parental understanding of children's asthma medications; patient's lack of perception of his or her own vulnerability to illness; patients' lack of information about the prescribed daily dosage/misconception about the disease and treatments; persistent misunderstandings about side-effects; drug abuse

(+) Perceiving that they are vulnerable to illness

Cancer

(-) Long distance from treatment setting

(-) lack of knowledge of health professionals about pain management; ' inadequate understanding of drug dependence by health professionals; health professionals' fears of investigation or sanction; poor delivery of care-education to the patient; poor delivery of care-education to family and caregivers; reluctance of health professionals to prescribe opioids for use at home

(+) Good relationship between patient and physician

(-) Nature of the patient's illness; poor understanding of the disease and its symptoms

(-) Complex treatment regimens; taking too many tablets; frequency of dose; having no treatment instructions; misunderstanding instructions about how to take the drugs; bad tasting medication; adverse effects of treatment; inadequate treatment doses; perceived ineffectiveness; unnecessary duplicate prescribing

(+) Monotherapy with simple dosing schedules

(-) Forgetfulness; misconceptions about pain; difficulty in taking the preparation as prescribed; fear of injections; anxieties about possible adverse events; no self-perceived need for treatment; not feeling it is important to take medications; undue anxiety about medication dependence; fear of addiction; psychological stress

Depression

No information was found

(-) Poor health education of the patient

(+) Multi-faceted intervention for primary care

(-) Psychiatric co-morbidity

(+) Clear instructions on management of disease; nature of the patient's illness; poor understanding of the disease and its symptoms

(-) High frequency of dose; co-prescribing of benzodiazepines; inadequate doses of medication

(+) Low frequency of dose; clear instructions on management of treatment

(-) Personality traits

Diabetes

(-) Cost of care; patients over 25 years (adherence to physical activity); older adolescents (insulin administration); older adolescents (SMBG); males (adherence to diet); females (adherence to physical activity); environmental high-risk situations

(+) Patients aged less than 25 years (adherence to physical activity); younger adolescents (insulin administration); younger adolescents (SMBG); males (adherence to physical activity); females (adherence to diet); social support; family support

(-) Poor relationship between patient and physician

(-) Depression; duration of disease

(-) Complexity of treatment

(+) Less frequent doses; monotherapy with simple dosing schedules, frequency of the self-care behaviour

(-) Depression; stress and emotional problems; alcohol abuse

(+) Self-esteem/self-efficacy

Epilepsy

(-) Long distance from treatment setting; under 60 years old; teenagers; poverty; illiteracy; unwillingness to pay the cost of medicines; high cost of medications; local beliefs or beliefs about the origin of illness
(+) Elderly patients (over 60 years old); children from family reporting less parental education; non-English speaking in an English-speaking community; lower income; recent immigrants

(-) Inadequate or non-existent reimbursement by health insurance plans; irregular or poor drug supply; lack of supplies of free medicines; poorly developed health services; lack of education about AEDs

(+) Good relationship between patient and physician

(-) Forgetfulness; memory deficits; duration and previous treatment failures; high frequency of seizures

(-) Complex treatment regimens; misunderstanding instructions about how to take the drugs; adverse effects of treatment

(+) Monotherapy with simple dosing schedules

(-) Disbelief of the diagnosis; refusal to take medication, delusional thinking; inconvenience of treatment; denial of diagnosis; lifestyle and health beliefs; parental worry about a child's health; behavioural restrictions placed on the child to protect his/her health; fear of addiction; doubting the diagnosis; uncertainty about the necessity for drugs; anxiety over the complexity of the drug regimen; feeling stigmatized by the epilepsy; not feeling that it is important to take medications

(+) Parents and child satisfied with medical care; not feeling stigmatized by epilepsy; feeling that it is important to take medications; high levels of stressful life events

HIV/AIDS

(-) Women (stress of childcare); low income; African American men; lack of social support

(+) Support of family and friends; Caucasian men

(-) Lack of clear instructions from health professionals; poor implementation of educational interventions

(+) Good relationship between patient and physician; support from nurses and pharmacists

(-) Asymptomatic patients

(+) Symptomatic patients; understanding the relationship between adherence and viral load

(-) Complex treatment regimens; close monitoring; severe lifestyle alterations; adverse effects of treatment; lack of clear instructions about how to take the medications

(+) Less frequent dose; fewer pills per day; fewer dietary restrictions; fitting medication to individual's lifestyle; belief that medication is effective

(-) Forgetfulness; life stress; alcohol use; drug use; depression; hopelessness and negative feelings; beliefs that alcohol and drug use interfere with medications

(+) Positive beliefs regarding the efficacy of antiretroviral medications

Hypertension

(-) Low socioeconomic status; illiteracy; unemployment; limited drug supply; high cost of medication

(-) Lack of knowledge and training for health care providers on managing chronic diseases; inadequate relationship between health care provider and patient; lack of knowledge; inadequate time for consultations; lack of incentives and feedback on performance

(+) Good relationship between patient and physician

(+) Understanding and perceptions about hypertension

(-) Complex treatment regimens; duration of treatment; low drug tolerability, adverse effects of treatment

(+) Monotherapy with simple dosing schedules; less frequent dose; fewer changes in antihypertensive medications; newer classes of drug: angiotensin II antagonists, angiotensin converting enzyme inhibitors, calcium channel blockers

(-) Inadequate knowledge and skill in managing the disease symptoms and treatment; no awareness of the costs and benefits of treatment, non-acceptance of monitoring

(+) Perception of the health risk related to the disease; active participation in monitoring; participation in management of disease

Tobacco smoking

(-) High cost of treatment

(+) Higher levels of education, older age

(-) Unavailability for follow-up or lost to follow-up; failure to recall the receipt of a prescription

(+) Access to free nicotine-replacement therapy; more frequent contact with physicians and pharmacists

(-) Daily cigarette consumption; expired CO; plasma nicotine and cotinine levels; Fagerstrom tolerance questionnaire (FTQ) scores; greater tobacco dependence; psychiatric co-morbidities; depression; failure to stop or reduce smoking during treatment

(-) Adverse events or withdrawal symptoms

(+) Attendance at behavioural intervention sessions

(-) Weight gain, no self-perceived need for treatment; no perceived effect of treatment

(+) Motivation; good relationship between patient and physician

Tuberculosis

(-) Lack of effective social support networks and unstable living conditions; cultural and lay beliefs about illness and treatment; ethnicity, gender and age; high cost of medication; high cost of transport; criminal justice involvement; involvement in drug dealing

(-) Poorly developed health services; inadequate relationship between health care provider and patient; health care providers who are untrained, overworked, inadequately supervised or unsupported in their tasks; inability to predict potentially non-adherent patients

(+) Good relationship between patient and physician; availability of expertise; links with patient support systems; flexibility in the hours of operation

(-) Asymptomatic patients; drug use; altered mental states caused by substance abuse; depression and psychological stress

(+) Knowledge about tuberculosis

(-) Complex treatment regimen; adverse effects of treatment; toxicity

(-) Forgetfulness; drug abuse, depression; psychological stress

(+) Belief in the efficacy of treatment; motivation

Common elements

(-) Long distance from treatment setting; low socioeconomic status; illiteracy; high cost of medication

(+) Family support

(-) Lack of knowledge and training of health professionals about treatment management and/or an inadequate understanding of the disease; poor relationship between patient and physician; short consultations; poor implementation of educational interventions

(+) Good relationship between patient and health professionals

(-) Poor understanding of the disease and its "side-effects"; depressive illness; psychiatric co-morbidities; asymptomatic disease; long duration of the disease

(+) Understanding and perception of the disease

(-) Complex treatment regimen; adverse effects of treatment; frequent doses; lack of clear instructions about how to take the medications

(+) Monotherapy; less frequent doses; fewer pills per day; clear instructions on management of treatment

(-) Forgetfulness; misunderstanding instructions about how to take the medications; inadequate knowledge and skill in managing the disease symptoms and treatment; anxieties about possible adverse effects; lack of self-perceived need for treatment; psychosocial stress; depression; low motivation

(+) Belief in the efficacy of treatment; motivation; perception of the health risk related to the disease

 

AEDs, Antiepileptic drugs; SMBG, self-monitoring of blood glucose; (+) factors having a positive effect on adherence; (-) factors having a negative effect on adherence; CO, carbon monoxide; (+) factors having a positive effect on adherence; (-) factors having a negative effect on adherence.

 

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