The complexity of adherence issue: A review of its scope and determinants

Abstract

Adherence is tremendously important for efficiency and safety of pharmacotherapy and has a significant influence on its clinical, economic and humanistic outcomes, which can be observed both on the individual level of the patient as well as on the overall healthcare system. The inadequate degree of adherence is a long-lasting and widely present problem which can have immense and long-term consequences. Therefore, the issue of adherence is a big challenge for medical professionals in clinical practice. The concept of adherence is based on cooperation between patients and medical team members in the process of therapy management. It is focused on patients and implies a two-way transfer of information, agreement and shared responsibility for success in realization of adequate therapy regime and defined goals. Although there are numerous methods for adherence assessment, the evaluation of this parameter is still considered problematic. The complexity of adherence can be seen in its multidimensionality since numerous factors which individually and in mutual interaction affect medicine-taking behavior and thus create a framework that determines the achieved level of adherence have been identified and analyzed. Considering the fact that poor adherence is one of the main preventable causes of unsatisfactory therapy results and excessive costs of medical care, it is evidently necessary to ensure a high quality base in the form of knowledge, skills and motivation at the healthcare system level for adherence evaluation and improvement, as well as a multidisciplinary approach based on coordinated activities of healthcare policy creators, researchers and medical professionals.

Adherenca je izuzetno važna za efikasnost i bezbednost farmakoterapije i značajno utiče na njene kliničke, ekonomske i humanističke ishode, što se može pratiti kako na individualnom nivou bolesnika, tako i na celokupnom zdravstvenom sistemu. Neadekvatan stepen adherence odavno je prisutan i široko rasprostranjen problem koji može imati velike i dugoročne posledice. Zato pitanje adherence predstavlja veliki izazov za zdravstvene profesionalce u kliničkoj praksi. Koncept adherence je utemeljen na saradnji bolesnika i članova zdravstvenog tima u procesu upravljanja terapijom. U potpunosti je orjentisan ka bolesniku i podrazumeva dvosmerni transfer informacija, dogovor i podeljenu odgovornost za uspešnost u realizaciji adekvatnog terapijskog režima i definisanih ciljeva. Iako postoji veliki broj metoda za procenu ostvarenog stepena adherence, još uvek se evaluacija ovog parametra smatra problematičnom. Kompleksnost adherence ogleda se u njenoj multidimenzionalnosti, budući da je identifikovan i proučen veliki broj faktora koji pojedinačno i u međusobnoj interakciji utiču na ponašanje bolesnika u vezi sa terapijom i tako kreiraju okvir koji determiniše ostvareni stepen adherence. Budući da je nizak stepen adherence jedan od glavnih preventabilnih uzroka nezadovoljavajućih terapijskih ishoda i prekomernih troškova zdravstvene zaštite, evidentna je potreba da se obezbedi kvalitetna baza u formi znanja, veština i motivacije na nivou zdravstvenog sistema za evaluaciju i unapređenje adherence, kao i multidisciplinaran pristup, koji je zasnovan na koordinisanim aktivnostima kreatora zdravstvene politike, istraživača i zdravstvenih profesionalaca.