Treatment adherence priorities: Results of an online survey of doctors providing outpatient services

Abstract

BACKGROUND: The opinion of doctors regarding the current issue of low patient adherence to modern medicine will help identify weaknesses in the system and methods to improve them. AIM: To assess the doctors’ opinion regarding the problem of adherence to outpatient treatments. MATERIALS AND METHODS: Using an online survey form (nine questions regarding adherence to outpatient treatments), 105 doctors were surveyed, including general practitioners (GPs; 51%), therapists (27%), cardiologists (21%), and other specialties (1%). The survey results were processed using hierarchical cluster analysis. RESULTS: The following clusters were identified: cluster 1 (K1), which included 62 respondents (GPs, 63% and therapists, 32%); and cluster 2 (K2), which included 43 respondents (cardiologists, 47%; and GPs, 35%). Doctors in both the clusters correctly determined the adherence to treatment (K1=77%, K2=88%; p=0.531), followed clinical practice guidelines when diagnosing a patient with cardiovascular disease (K1=66%, K2=88%; p=0.020), believed that the doctor’s behavior influences the patient’s adherence (K1=86%, K2=98%; p=0.045), and believed that patients should be educated regarding their disease (K1=84%, K2=100%, p=0.005). They believed that the most significant topics to be taught were arterial hypertension, heart failure (HF), coronary artery disease, arrhythmia, and chronic kidney disease (K1=81%, K2=86%; p=0.876). Furthermore, they agreed that the use of technology and mobile apps (K1=61%, K2=70%, p=0.371) could increase patient adherence to treatment. Twenty doctors correctly identified the medications indicated for HF with reduced ejection fraction to improve patient prognosis (K1=2, K2=18; p 0.001). The remaining respondents answered partially correctly (K1=97%, K2=58%; p 0.001). The respondents identified that the lack of time at appointments to explain and improve the patient’s motivation for treatment (K1=47%, K2=47%, p=0.226) and the patient’s low health literacy (K1=26%, K2=35%; p=0.226) were the most significant reasons for low adherence. CONCLUSION: Most physicians providing outpatient services are aware of the concept of medication adherence and following clinical practice guidelines when managing patients with cardiovascular pathology. The lack of sufficient time for outpatient appointments and the patient’s low health literacy are the leading factors of low adherence to treatment. Thus, the doctors unanimously believe that educating patients regarding their disease will increase adherence to treatment.