Therapeutic Adherence: What Is It And How Can It Be Improved?
Therapeutic adherence is a very important issue: the outcome of a cure depends to a large extent on it. The question is of a certain complexity, since there are many factors that contribute to it.
The first difficulty lies in the fact that there is still no agreement on the exact definition of the term. It is often referred to simply as adhering to medical prescriptions. Some, however, consider it a multifactorial phenomenon.
The causes and consequences of a lack of or poor therapeutic adherence are also manifold. This means that each case is different. For this reason, it is not easy to understand or deal with this phenomenon. Let’s find out step by step.
What is therapeutic adherence?
Therapeutic adherence is the patient’s active and voluntary commitment to follow the therapy prescribed by the doctor. Its goal is to achieve a specific result. The commitment must be agreed between the patient and the doctor.
Therapeutic adherence encompasses a set of behaviors. From the patient’s point of view, it involves consenting to treatment and actually following directions. It also means avoiding risky behaviors and adopting a lifestyle that is in accordance with the therapy.
From the physician’s point of view, it involves, first of all, the ability to establish a good therapeutic alliance with the patient. The doctor must offer clear instructions and make sure they are well understood. At the same time it must motivate the patient to follow the therapy voluntarily.
Factors Affecting Therapeutic Adherence
There are many factors that can facilitate or, conversely, hinder therapeutic adherence. Among the main ones we find:
- Relationship between doctor and patient. It refers to the quality of the bond that is established between them. When it is positive, the adhesion is higher. Communication is essential: the clearer and more motivating the instructions, the better the results.
- Therapeutic regimen. The most influencing factors are the complexity of the dosage and the side effects of the treatment. Single-dose therapies are, of course, easier to follow. In addition, greater side effects correspond to an increase in difficulties.
- Features of the disease. When treatment relieves symptoms of the disorder quickly, adherence is greater. Asymptomatic patients are those who show less adherence.
- Psychosocial factors. Personal beliefs, attitudes, lifestyle and values can facilitate or hinder therapy. The perception of the efficacy of the treatment and trust in the doctor are of particular importance.
- The context. If the patient receives support from their environment, it will be easier for them to follow the doctor’s directions. Aspects such as religion and the attitude of family members towards health have a great influence.
Consequences of non-adherence
The lack of therapeutic adherence has many consequences, mainly of a clinical and economic nature. However, this is difficult to quantify. Many patients, in this case, simply avoid talking about it or are not entirely sincere.
The clinical consequences depend on the degree and type of non-compliance with medical prescriptions. Sometimes the therapy is never started, while in other cases it stops immediately after departure. The effects are variable, based on the patient’s disease and health condition.
In general, not following the doctor’s prescriptions leads to an increase in health care costs. It translates into a higher number of hospital admissions and access to clinics or the emergency room. It can also lead to the need to change therapy and to undergo further diagnostic tests.
How to achieve greater adherence to therapy?
There is a lot of research in progress relating to the best strategies to achieve higher therapeutic adherence. Even if the last word has not yet been said in this regard, in principle the following measures are necessary:
- Simplify, as far as possible, the statute of limitations. The fewer doses and fewer medications are used, the easier it will be for the patient to follow therapy.
- Influencing behavior. It includes actions that serve to shape the patient’s behavior towards treatment, such as reminders, checks, gratification, etc.
- Educational aspects. The patient not only needs to know when or how to take a medicine, but also why it is important that he do so. This will lead him to follow the treatment voluntarily and without the need for any pressure.
- Family and social support. It includes actions aimed at promoting social support: home assistance, policy of contributions to the purchase of drugs, etc. In addition, interventions aimed at increasing the involvement of people in contact with the patient.
- Training of health professionals. This aspect concerns, in a special way, the acquisition of communication and motivation techniques.
All these strategies should be applied in a coordinated and synergistic way. The more this result can be achieved, the greater will be the therapeutic adherence. After all, the relationship and communication that are established between doctor and patient are fundamental for the correct success of a treatment.
