Factors of non-adherence to therapy in chronic patients with pathologies covered by the exceptional participation regimen in Portugal
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abstract
Medication adherence is a multidimensional phenomenon determined by the interaction of factors of diverse nature. The World Health Organization classified in five groups the reasons for non-adherence to therapy, related to, patient, disease, therapy, health system and socioeconomic factors [1].
Aim: To identify the most prevalent reasons for non-adherence to therapy and to verify the existing differences taking into account the socioeconomic variables.
Method: A random probabilistic sample of 141 outpatient suffering from pathologies covered by the Exceptional Participation Regimen (EPR), with dispensing medicines at the hospital pharmacy, treated at the Local Health Unit of the Northeast in Portugal, was selected.To collect the data, was applied a questionnaire, by interview, that included socioeconomic variables and a list of non-adhesion factors adapted from Cabral and Silva [2], between July 2017 and April 2018. The list of factors for non-adherence to the therapy consisted of 35 factors that were later aggregated into three dimensions. The first dimension "extrinsic motives", consisted of 11 reasons that could lead patients not to follow completely the indications recommended by the doctor. The second dimension "intrinsic motives" was constituted by 20 factors related to the characteristics of the medicines and the therapeutics. Finally, the third dimension "doctor-patient relationship" included 4 items describing aspects of the doctor-patient relationship that could contribute to non-adherence to the therapy. The SPSS 24.0 software was used to analyse the data. The internal consistency was analysed through Alpha Cronbach. For the comparison of groups, the non-parametric Mann-Whitney test was used at a significance level of 5%.
Results: In the "extrinsic motives" dimension, the three most prevalent factors were "patient does not like to have the trips to go to consultations" (39%), "patient does not like to take medications" (37.6%) and "patient does not like to think he is ill "(31.9%). It was the female patients with the lowest level of education and the lowest income who were most likely to leave the treatment. The "intrinsic motives" that stand out were: "the schedule of the shots" (36.9%), "drugs were difficult to take" (29.8%) and "treatment duration was long" (29,1%). It was women, aged 65 years old or more, without professional occupation, with lower levels of income and schooling who were less compliant with medical indications. Finally, taking into account the "medical-patient relationship", "doctors prescribe more medicines" (35%); "I am afraid to ask for clarification and ask questions" (18.4%) and "I do not understand what doctors say" (17.7%) stand out. It was the elderly, retired, and married patients who most often experienced less cooperative situations with their physician.
Conclusion: The socioeconomic variables are differentiated from the (non) compliance by the medical indications.
References
1. World Health Organization. Adherence to long-term therapies: Evidence for action. Geneva: World Health Organization; 2003. [Access date may, 2017]. Available from:http://www.who.int/chp/knowledge/publications/adherence_report/en/
2. Cabral, M., Silva, P. A adesão à terapêutica em Portugal: Atitudes e comportamentos da população portuguesa perante as prescrições médicas. APIFARMA, 2010.
