Medical regimen adherence: Concepts, assessment, and interventions.

Johnson, Suzanne Bennett; Carlson, Dawn Newman

doi:10.1037/11589-010

Cited by 9 publications

(12 citation statements)

References 83 publications

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“…These terms are often used interchangeably, but they impose different views about the relationship between the patient and the health care professional [38][39][40]. 'Compliance' , for instance, has been viewed by many as having the negative connotation that patients are subservient to prescribers [41][42][43][44][45]. The term 'concordance' , introduced originally to describe the patient-prescriber relationship, is sometimes incorrectly used as a synonym for 'compliance' [46][47][48][49][50][51][52][53][54][55][56][57].…”

Section: Introductionmentioning

confidence: 99%

A New Taxonomy for Describing and Defining Adherence to Medications

Vrijens

Geest

Hughes

et al. 2011

British Journal of Clinical Pharmacology

232

316

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Interest in patient adherence has increased in recent years, with a growing literature that shows the pervasiveness of poor adherence to appropriately prescribed medications. However, four decades of adherence research has not resulted in uniformity in the terminology used to describe deviations from prescribed therapies. The aim of this review was to propose a new taxonomy, in which adherence to medications is conceptualized, based on behavioural and pharmacological science, and which will support quantifiable parameters. A systematic literature review was performed using MEDLINE, EMBASE, CINAHL, the Cochrane Library and PsycINFO from database inception to 1 April 2009. The objective was to identify the different conceptual approaches to adherence research. Definitions were analyzed according to time and methodological perspectives. A taxonomic approach was subsequently derived, evaluated and discussed with international experts. More than 10 different terms describing medication-taking behaviour were identified through the literature review, often with differing meanings. The conceptual foundation for a new, transparent taxonomy relies on three elements, which make a clear distinction between processes that describe actions through established routines ('Adherence to medications' , 'Management of adherence') and the discipline that studies those processes ('Adherence-related sciences'). 'Adherence to medications' is the process by which patients take their medication as prescribed, further divided into three quantifiable phases: 'Initiation' , 'Implementation' and 'Discontinuation' . In response to the proliferation of ambiguous or unquantifiable terms in the literature on medication adherence, this research has resulted in a new conceptual foundation for a transparent taxonomy. The terms and definitions are focused on promoting consistency and quantification in terminology and methods to aid in the conduct, analysis and interpretation of scientific studies of medication adherence.

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Section: Introductionmentioning

confidence: 99%

A New Taxonomy for Describing and Defining Adherence to Medications

Vrijens

Geest

Hughes

et al. 2011

British Journal of Clinical Pharmacology

232

316

View full text Add to dashboard Cite

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“…28 However, limited research has examined the same relationship in the BMT literature. This study is one of the first efforts to describe the prevalence and predictors of non-compliance in AHSCT recipients treated in the outpatient setting.…”

Section: Discussionmentioning

confidence: 99%

Predictors of non-compliance in autologous hematopoietic SCT patients undergoing out-patient transplants

Mumby

Hurley

Samsi

et al. 2011

Bone Marrow Transplant

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Non-compliance has received significant attention in medicine, yet few studies have examined its correlates in autologous hematopoietic SCT (AHSCT) patients. This study examined predictors of non-compliance in a sample of 151 AHSCT patients treated in an outpatient setting. Before AHSCT, participants completed a validated measure of mood and retrospective chart reviews were conducted to assess non-compliance during AHSCT, defined as refusal of oral hygiene, prescribed exercise programs, oral nutrition and/or prescribed medications. We found 121 patients (80%) were non-compliant with an aspect of the AHSCT regimen on 1 or more days; mean percentage of noncompliant days was 16.6 (s.d. 15.6). Men were more likely than women to be non-compliant (Po0.05); as were participants with an elevated depression score (Po0.05).Stepwise regression models identified significant predictors of non-compliance: gender, depression, global distress and nausea and vomiting severity (P-values all o0.01). Further analysis revealed that the interaction of the psychological variables with gender was a more robust predictor of noncompliance (Po0.001). For outpatient AHSCT, our findings suggest the need to broaden conceptualizations of risk factors for non-compliance and the importance of assessing patient barriers to compliance to ensure optimal treatment outcome.

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“…52 Despite the relative consensus on a definition of adherence, there are often different approaches to operationally assessing and measuring adherence. 53 Some researchers focus on global, comprehensive assessments of adherence, while other focus on specific adherence tasks separately. Therefore, the how, when, where, and by whom these adherence behaviors are assessed, result in different ratings of degrees of medical adherence.…”

Section: Adherencementioning

confidence: 99%

“…Therefore, the how, when, where, and by whom these adherence behaviors are assessed, result in different ratings of degrees of medical adherence. 53 It is recommended that adherence measures should be continuous, dynamic, and capture specific regimen behaviors relevant to the disease population. Although diabetes regimen adherence has been measured using different methods (e.g., self-report measures, diary/interview measures, and electronic monitoring), there is empirical evidence demonstrating the associations between many of these adherence measures and glycemic control.…”

Section: Adherencementioning

confidence: 99%

Behavioral Factors Influencing Health Outcomes in Youth with Type 1 Diabetes

Kichler¹,

Moss²,

Kaugars³

2012

US Endocrinology

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Adherence to medical regimen is often identified as a hallmark modifiable factor that impacts health outcomes for those with chronic medical illnesses. Rapoff suggests that adherence to medical regimens is estimated to be between 50-55 % for all chronically ill patients. 1 He describes a number of patient and family (e.g., demographic, adjustment/coping, family involvement), disease-and regimen-related correlates to adherence; however, correlates do not imply causation and should be interpreted cautiously.1 Researchers have rated non-adherence rates to be between 20 to 93 % 1-3 for youth with type 1 diabetes and have found that adherence is widely accepted as related to diabetes control. 4In a recent review article, Modi et al. make a distinction between two constructs: self-management (i.e., the interactions of health behaviors and related processes that patients and families engage in to carefor chronic medical conditions) and adherence (i.e., the extent to which a person's behavior coincides with medical or health advice). 5 In their Pediatric Self-Management Model, self-management influences adherence, which then affects outcomes, including health outcomes. The authors also suggest that there may be certain self-management factors that impact outcomes without the mediating role of adherence in pediatric conditions. 5This present review article will focus on the first two of three stages in the Pediatric Self-Management Model, self-management and adherence, to discuss the behavioral factors that may influence health outcomes for youth with type 1 diabetes during adolescence (see Figure 1). Findings from individual, family, peer, and group therapy interventions that have targeted these behavioral factors in order to improve health outcomes will then be outlined. Self-managementModi et al. describe the construct of self-management as having three components. 5 The first component is self-management behaviors, which are the actual behaviors performed by the youth and/or family in order to care for a chronic medical illness. Secondly, there are contextual variables, which are four systems that impact how the self-management behaviors occur. These include individual, family, community, and healthcare domains. Finally, there are processes that link the self-management behaviors with the contextual systems.These processes include individuals' cognitive, emotional, and social perceptions. Three components of self-management, self-management behaviors, contextual variables, and processes as they relate to youth with type 1 diabetes, will be reviewed below (see Table 1). Self-management BehaviorsSelf-management behaviors, defined as examples of the 'neutral'behaviors that are employed to help manage a chronic medical illness, have been widely examined in youth with type 1 diabetes.Some examples of self-management behaviors that researchers have repeatedly identified as relevant to the management of diabetes are parental involvement and collaboration, the division of diabetes responsibility in the family and subsequent ...

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Medical regimen adherence: Concepts, assessment, and interventions.

Cited by 9 publications

References 83 publications

A New Taxonomy for Describing and Defining Adherence to Medications

A New Taxonomy for Describing and Defining Adherence to Medications

Predictors of non-compliance in autologous hematopoietic SCT patients undergoing out-patient transplants

Behavioral Factors Influencing Health Outcomes in Youth with Type 1 Diabetes

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