An Adaptable Framework for Factors Contributing to Medication Adherence: Results from a Systematic Review of 102 Conceptual Frameworks

Abstract

Objective To summarize the available conceptual models for factors contributing to medication adherence based on the World Health Organization (WHO)’s five dimensions of medication adherence via a systematic review, identify the patient groups described in available conceptual models, and present an adaptable conceptual model that describes the factors contributing to medication adherence in the identified patient groups. Methods We searched PubMed®, Embase®, CINAHL®, and PsycINFO® for English language articles published from inception until 31 March 2020. Full-text original publications in English that presented theoretical or conceptual models for factors contributing to medication adherence were included. Studies that presented statistical models were excluded. Two authors independently extracted the data. Results We identified 102 conceptual models, and classified the factors contributing to medication adherence using the WHO’s five dimensions of medication adherence, namely patient-related, medication-related, condition-related, healthcare system/healthcare provider-related, and socioeconomic factors. Eight patient groups were identified based on age and disease condition. The most universally addressed factors were patient-related factors. Medication-related, condition-related, healthcare system-related, and socioeconomic factors were represented to various extents depending on the patient group. By systematically examining how the WHO’s five dimensions of medication adherence were applied differently across the eight different patient groups, we present a conceptual model that can be adapted to summarize the common factors contributing to medication adherence in different patient groups. Conclusion Our conceptual models can be utilized as a guide for clinicians and researchers in identifying the facilitators and barriers to medication adherence and developing future interventions to improve medication adherence. Protocol Registration PROSPERO Identifier: CRD42020181316

Intentionality in adherence to long-term therapies. Results from an online survey of 3,001 patients with cardio-metabolic pathologies in France

“…This description takes the form of a five-part “donut” of all factors that may be considered determinants of adherence/nonadherence: patient-related factors, medication-related factors, condition-related factors, health system-related factors, and socioeconomic factors. 22 The originality of the model presented in our paper is vested in its demonstration of the existence of interconnections between the first three blocks: physician attitudes, patient characteristics, and nature of the treatment. Our model shows that it is necessary to avoid “intentional nonadherence” by playing on the nature of the treatment and the shared medical decision.…”

“…2 Studies have related multiple determinants of nonadherence involving the nature of the disease, the treatment, patient characteristics, and quality of physician-patient relationships. [17][18][19][20][21][22] The distinction between intentional and unintentional nonadherence was an important step in understanding the phenomenon, 23 elucidating that some patients rationally chose not to follow medical prescriptions while others neglected their prescribed doses for reasons beyond their control, for instance, forgetting or weaker medicationtaking routines, or habit strengths. 24 Notably, the frequency of unintentional nonadherence increases during the first six months, while intentional nonadherence remains relatively stable.…”

Drug-handling problems and expectations of the ideal pediatric drug—reported by children and their parents

“…As described in the framework for factors contributing to medication adherence by Peh et al [6] medication-related factors have a key role for the patient's adherence and, consequently, therapeutic success. Examples for relevant medication-related factors especially in pediatric patients are dosing, administration, the complexity of the medication regimen, or medication properties such as drug formulation.…”

Medication adherence in migraine patients (data of an online survey)

“…Несмотря на значительные достижения в лечении мигрени, уровень медицинской помощи этим пациентам остается неудовлетворительным. Основными барьерами на пути оптимального ведения пациентов являются низкий уровень обращаемости за медицинской помощью, низкий уровень ее диагностики в клинической практике, а также недостаточное использование стратегий профилактической терапии [2,3]. Исходя из данных эпидемиологических исследований, в целом профилактическая терапия должна быть назначена примерно 40% обратившихся к врачу пациентов с мигренью, тогда как в реальной клинической практике она применяется только в 13% случаев [3].…”

“…Основными барьерами на пути оптимального ведения пациентов являются низкий уровень обращаемости за медицинской помощью, низкий уровень ее диагностики в клинической практике, а также недостаточное использование стратегий профилактической терапии [2,3]. Исходя из данных эпидемиологических исследований, в целом профилактическая терапия должна быть назначена примерно 40% обратившихся к врачу пациентов с мигренью, тогда как в реальной клинической практике она применяется только в 13% случаев [3]. Но одним из существенных препятствий к эффективному лечению больных является низкий уровень приверженности пациентов профилактическому лечению [4,5].…”