Adherence to therapeutic in outpatients: literature review
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abstract
Non-adherence to therapeutic is a widespread problem that contributes to the worsening of chronic diseases and to increase the expenditure on health care [1-3].
Objective: To present a review of the literature on the subject "Adherence to therapy" in outpatients.
Methods: A search was carried out in the Medline database and the combinations of words Medication, Adherence and Outpatients were used for the period from 2010 to 2017. including only articles that adopted the Morisky Medication Adherence Scale (MMAS) to measure adherence to medication and studies developed in hospital context. In addition, articles with non-conventional therapies were excluded, namely those that resorted to the use of medicinal plants. Information was collected on the place of the study, period, type of study, sample, pathology, adherence to therapy in terms of rate or score (mean) and factors identified as being associated with non-adherence to therapy.
Results: The search retrieved 461 publications and 44 were included in the analysis. The included studies are from Europe, Asia, Africa and America. Most of the studies were observational (84.1%). The remaining studies were interventional studies (15.9%). There were, also, 4 multicenter studies. In most studies, the Morisky scale was used with 8 item and only 31.8% used the shorter scale with 4 items. The sample sizes ranged from 34 to 2595 chronic patients and were mostly non-probabilistic (convenience) (75%). The most common pathologies were: diabetes, hypertension, diabetic retinopathy and hypercholesterolemia (34.1%); psychiatric diseases (25%), cardiovascular diseases (18.2%), among others. Taking into account the variable "adherence to therapeutic", 84.5% of the studies used a dichotomous variable. The others determined the score (mean with associated standard deviation). In general, therapeutic adherence was low. Considering the adherence rates, the lowest were recorded in the treatment of hypercholesterolemia (7.4%) and the highest was recorded in the treatment of hypertension in patients with apnea (83%). It should be noted that the cut-off point did not remain the same in all studies. The factors most commonly referred to as being associated with non-adherence were age, forgetfulness, lack of social support, the complexity of intake and stopping medication when the patient feels better.
Conclusion: Interventional studies show significant improvements in adherence, comparing the situation before and after the intervention. Therefore, it is a priority to implement measures that improve adherence to therapy.
References
1. Conn VS, Ruppar TM, Chan KC, Dunbar-Jacob J, Pepper GA, Geest SD. Packaging interventions to increase medication adherence: systematic review and meta-analysis. Current Medical Research And Opinion 2015, 31(1):145-60.
2. Ababneh MA, Al-Azzam SI, Alzoubi KH, Rababa'h AM. Adherence in outpatients taking warfarin and its effect on anticoagulation control in Jordan. Int J Clin Pharm. 2016, 38(4):816-21.
3. Napolitano F, Napolitano P, Angelillo IF. Collaborative Working Group. Medication adherence among patients with chronic conditions in Italy. Eur J Public Health 2016 26(1):48-52.
Non‐adherence to therapeutic with chronic treatments may compromise patient health,
increase care costs and lead to unnecessary consultations and diagnoses, as well as additional
treatments with potentially serious side effects1‐5, which can cause significant negative
impacts on patients' quality of life5. Chronic diseases, due to their intrinsic nature, are
particularly susceptible to non‐adhesion5. According to the World Health Organization (WHO),
inadequate adherence to drug therapy in chronic diseases is considered a worldwide problem
of great magnitude6. In developed countries only 50% of individuals suffering from chronic diseases adhere to drug treatments. While precarious access to health care, lack of adequate
diagnosis and limited access to medicines, and poor adherence to drug therapy in developing
countries are conditions that challenge successful chronic disease.
This work is supported by FEDER/COMPETE 2020
[Project No. 006971 (UID/SOC/04011/2013); Funding Reference: POCI-01-
0145-FEDER-006971]; and by UDI/IPG and iBiMED/UA.
This work is supported by FEDER/COMPETE 2020 [Project No. 006971 (UID/SOC/04011(2013); Funding Reference: POCI-01- 0145-FEDER-006971]; and by UDI/IPG and iBiMED/UA.
