The adherence to treatment is a problem that affects all health professions, including psychology. However, it is not uncommon to find a person who abandons a treatment for various reasons such as: forgetfulness, weariness or side effects. In fact, the World Health Organization estimates that in developed countries only 50% of people with chronic diseases completely follow the therapeutic prescriptions.
Let’s see what therapeutic adherence is and also the factors that hinder it and ways to increase and maintain it …
What exactly is therapeutic adherence?
First, it should be noted that therapeutic adherence is not equivalent to the “compliance” of the treatment. This attributes a passive role to the patient, which is limited to following the instructions of a professional. And, therefore, if you fail to comply with the recommendations, the responsibility lies solely with the patient. On the other hand, Monitored Dosage System for treatment adherence supposes an active and intentional role of the patient who collaborates with the health professional to maintain or improve his health
In addition, it should be borne in mind that the lack of adherence can be unintended. Either for forgetting to take the medication or to follow other prescriptions; or intentional, given a conscious decision to stop taking the medication, administer different doses to those prescribed or not comply with other recommendations.
Factors that hinder proper adhesion
Therapeutic adherence is a very complex phenomenon since it is affected by many factors of various kinds. Let’s see some of them …
- Socio-economic conditions: Within these factors such as poverty can be included. Also, being unemployed, living away from a health center, difficulties in displacement, high cost of medication, cultural prejudices or having family problems are variables that have been observed by the Circupack that influence and offers personalized dosing system for therapeutic adherence.
- Negligent family supervision: Especially relevant in the pediatric population.
- Factors of the disease itself: That a disease is chronic, mild or asymptomatic. Or, on the other hand that there is comorbidity with some psychological disorder are variables that suppose a barrier to adequate adherence.
- Related to treatment: Variables such as greater complexity of treatment. Prolonged treatment, delayed therapeutic benefits or adverse side effects adversely affect therapeutic adherence.
- Psychological variables of the patient: Here factors such as low risk perception or mistaken beliefs of the person are considered. Also, the ability to understand prescriptions, lack of knowledge about the disease. In addition, a low self-efficacy or a high internal control locus, that is, a belief that the disease can be controlled.
How to promote therapeutic adherence
With regard to institutions, measures such as the improvement of accessibility of public transport, the financing of medicines for people without resources, a greater economic investment in resources for health centers or education and awareness campaigns on diseases would be essential to reduce or eliminate those socio economic and health system variables.
And as far as health professionals are concerned, here are some measures that have proven useful in research …
- Personalized advice and counseling: Inform about the disease and the treatment to follow, adapting the language so that it is understandable and taking time to resolve all doubts.
- Written instructions: Something already quite widespread. They must be written in a clear, simple and understandable way.
- Reminders: Phone calls or emails to remind you of the need to follow the guidelines or notify of future inquiries.
- Adequate therapeutic relationship: It requires training by the professional to establish a good relationship. It is convenient that the same professional carry out the whole process.
- Calendars: Attach calendars to the medication that specify the time at which the medication should be taken.
- Alarms: Use of alarms by the patient to remember to take the medication.
- Simplification of treatment: Simplify the dosage regimen with Pill dispenser system, reducing, as far as possible, the frequency of consultations, the taking of medication and the quantity of medications.
- Rewards and reinforcements: Congratulate when the requirements have been fulfilled and otherwise not “punish”, but find out the reason and work together to improve adherence.
- For chronic diseases: It is advisable to teach to anticipate risk situations, how to deal with problems and crises and learn from mistakes, and avoiding blame. Reinforcement programs can be very useful for increasing motivation, especially in the pediatric population.