Five things to know about adherence

“Drugs don’t work in patients who don’t take them”  ( C. Everett Koop)

A few weeks ago I went to the launch of the CARE programme (Centre for Adherence Research and Education) as part of King’s Health Partners.

The Centre aims to improve patients’, caregivers’ and health and social care staff awareness of the treatment non-adherence challenge and to provide approaches to help patients engage with their treatment. “CARE gives us the opportunity to coordinate the wide range of our current research into a core programme and enables us to translate our research insights into healthcare professional training and improved patient outcomes” according to Professor John Weinman, Professor of Psychology as Applied to Medicines, King’s College London.

I wanted to write a brief blog as I want to champion this initiative, this academic centre, as it should be used or consulted more widely in all areas in healthcare, also in healthcare communications.

Adherence is one of the terms that was firstly represented in so-called ‘patient-centric’ pharmaceutical conferences as adherence is clearly linked to treatment (mainly to prescription retention). Pharmaceutical companies understand what it is and why it is important for all players in the healthcare environment, however as there are no clear actions or strategies to implement to increase adherence in patients successfully, some initiatives are canceled, not implemented or not even started.

I believe that healthcare communications agencies can support pharmaceutical companies to tackle the non-adherence challenge or at least take steps to inform campaigns and strategies. For example, disease awareness campaigns could contain illness perceptions parts or general treatment belief insights.

5 things to know about ‘adherence’….

  1. ADHERENCE is the extent to which patients follow  medical treatment and advice
  2. First TYPE OF NON-ADHERENCE: Unintentional non-adherence:

A range of possible factors:

  • Poor HCP-Patient Communication
  • Low patient satisfaction and/or recall
  • Problems in planning/executive function or prospective memory
  • Financial or other barriers
  1. Second type of NON-ADHERENCE: Intentional non-adherence

Patients know what to do and how to do it but they are reluctant to adhere because of either

  • Treatment doesn’t make sense
  • Worries or concerns about the treatment
  1. How can the problem be addressed? We need to understand the types and causes of non-adherence and we need to tailor interventions to take account of these. Find out what the key beliefs influencing adherence to treatment are for patient(s)? What are their patients’ perceptions of the illness and what do they believe about the treatment.
  2. The Capability, Opportunity and Motivation (COM-B) model aims to explain human behaviour in terms of the range of mechanisms that may be involved in behaviour change, and a recent paper, published in The European Health Psychologist and discusses the application of COM-B to medication adherence.
  • Capabilities – things that are intrinsic to a person which can be psychological (for example understanding of the disease and treatment, memory and planning) or physical (for example adapting to lifestyle changes and dexterity)
  • Opportunities – things that are external to a person and can be physical (for example cost, access to medicines, complexity of treatment regimen and relationship with their healthcare professional team) or social (for example stigma associated with the disease, religious and cultural beliefs)
  • Motivators – those things that energise and direct behaviour which can be reflective (for example the perception of the illness and beliefs about the treatment as well as expectations around outcomes) or automatic (for example stimuli or cues to take action and mood state).

 

The take-home message: a person’s adherence to treatment may be affected by one, some or all of these factors to varying degrees and so any programme or campaign which looks at influencing adherence should be tailored to address those factors that most influence that individual’s behaviour.

 

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