This lack of adherence to treatment Can be given in pharmacological treatments and in the modification of harmful or high-risk habits such as diet, stress, alcohol or tobacco. Also to the abandonment of the treatment or breach of the revisions. In addition, it is a condition inherent to the patient and discouraging.
In general terms, proper compliance with any therapeutic prescription involves performing a series of tasks that require not only knowing what to do, but how and when to do it.
Treatment adherence statistics
If we talk in statistical terms, we obtain the following approximate data: about 30% do not follow curative treatments, 70% do not comply with preventive programs and more than 50% of patients with a chronic disease do not adhere to treatments.
In addition, around 50% of patients do not go to doctor's reviews. For those who are prescribed medication, between 20 and 60% will leave treatment earlier than prescribed and between 25 and 65% will make errors in administration. Even 35% will put your health at risk. It is curious that even among health professionals there are problems of adherence, around 20%.
When is the highest prevalence of adherence observed? For those cases where directly supervised medication is required and in disorders with an acute onset.
And the lowest prevalence? In those chronic patients in whom treatment requires changes in their Lifestyle . For example, in patients with food allergies, they must modify their eating habits or in diabetic and hypertensive patients, who depend on a medication and a change in eating habits.
Impact of not following a treatment
Failure to follow treatment has enormous implications. The most obvious are:
- Increase in economic spending.
- Increase in health expenditure.
- Increase in social costs.
- Malaise and social and psychological maladjustment of the patient.
Common Problems with Medical Prescriptions
Sometimes a barrier for patients to adhere to treatment is the difficulty in understanding the prescriptions of doctors.
For example:"resting"a time when taking a medication on a regular basis,"consuming or eliminating certain foods or activities according to the type of illness or condition of the patient"eating by two pregnant women"and"avoiding exercise in asthmatic or diabetic children ".
Let's look at some examples of not very clear prescriptions:
Example 1: The doctor tells you to take an ibuprofen every 6 hours
- problems : You may not act as prescribed, for example, when deciding whether to wake up in the middle of the night to ensure the interval between taking and taking, or what to do if you forget a dose.
Example 2: The doctor tells you that you should reduce fats because of their high cholesterol
- problems : You will have to change some habits, like to leave tapas with the companions of the work after the working day. Also in your house you must modify your eating habits And instruct people who live with you and cook, who should remove some foods from your diet. In addition, you may realize that following the medical prescription causes you more headaches and more discomfort than failure to comply.
Example 3: The doctor tells you that it is convenient that when you wake up in the morning drink a glass of water tempered with lemon to purify the body
- problems : Although it is a simple practice that does not interfere with your life or require modification of your daily activities, you do not remember almost never to take it.
In short, the monitoring of therapeutic prescriptions is not an issue that requires only the will of the person.
It also requires effective physician prescribing, environmental control, and contingent compliance benefits. That is, the person experiences a remission of symptoms, an improvement of the general state of his body, expectations of improvement, a relationship of trust with the doctor...
Adherence is said to exist when there is a coincidence between the clinician's instruction and the patient's behavior.
Theoretical models of adherence to treatment
From different theoretical perspectives it is tried to give explanation to the adherence to the treatment. Thus, we find biomedical models, behavioral models, operant models, communication models and cognitive models.
Biomedical models
Biomedical models suggest that there are a number of conditions in the person and in the disease that would predict noncompliance.
Haynes et al. (1987) argue that there are a number of predictive characteristics of non-compliance with therapies in the patient (eg lack of understanding of the instructions to follow), disease and therapeutic relationship.
In turn, they affirm that other conditions exist that favor an increase of the therapeutic adhesion. However, they do not explain how these conditions are established or modified in contexts and it could be that such behaviors were only specific behaviors resulting from a particular context.
Behavioral models
Within the behavioral models we speak of operant models.
From these, the use of techniques such as behavior molding, environmental planning and contingency management of reinforcement have been considered as influential in the development of adherence behaviors.
However, it should be borne in mind that the complexity of the problem and the implication of numerous variables in adherence can not be solved by paying attention solely and exclusively to environmental control and to the reinforcement of the behaviors involved.
Communication Models
As for the communication models, the improvement of the processes of reception, understanding and retention of messages is considered. This has been promoted through information campaigns.
Cognitive models
From the Theory of Self-efficacy Reference is made to the person's conviction of being able to successfully perform the conduct required to produce certain results. Efficacy expectations are proposed as a fundamental determinant in the choice of activities, how much effort the subject will use and how long it will be in facing stressful situations.
From the Health Belief Model , The person needs to fulfill some conditions to carry out a health behavior, such as:
- Be minimally motivated.
- You have no information relevant to your health.
- Do not see yourself as vulnerable or potentially susceptible to illness.
- Be convinced of the effectiveness of the intervention.
- To see few difficulties in the implementation of health behavior.
Even so, the role of other additional variables such as the structure of the treatment regimen or the environmental and social conditions that regulate compliance is important. In addition, patient expectations are important, but they are not sufficient to predict adherence in all cases.
On the other hand, Theory of reasoned action Of Ajzen and Fishbein, supposes that the people before deciding to carry out an action consider the implications of their actions.
According to this model the determinant is the intention of the person to perform the action, in addition the intention is in function of two components:
- The attitude toward action, which is a function of belief about the most likely outcomes of that behavior (behavioral belief) and the assessment of that behavior (assessment of results).
- The belief of the person of the existence of social pressures to do or not perform the behavior in question (normative belief).
As we see, this theory emphasizes the mediating role of what the person tells himself about his manifest behavior (adherence to therapeutic prescriptions, in this case).
Finally, from the Theory of social action , Ewart in 1993, argues that adherence must be analyzed simultaneously as a desirable habit, as a process of change through which habits are modified and as the result of contexts in which changes occur.
The maintenance of a healthy habit lies in the self-regulation between self-protective activities and their biological, emotional and social consequences experienced. To create healthy habits would establish very routine behavioral chains. For example, associate the sound of the alarm clock with the glass of water you have to take nothing more wake you and breakfast with take your pills. Or, associate the thought of recurring nervousness every time you get up to go to work, knowing that you will use relaxing music.
Such chains should be integrated into other habitual behaviors of the person and should reduce personal risk. In addition, personal actions must be interconnected with those of family members or relevant people, so that the greater the interconnection, the more difficult it is to alter a routine, since it involves changing the routines of many people.
Factors associated with therapeutic adhesion
Numerous investigations related to therapeutic adherence show the participation of variables grouped in those related to the disease, the treatment, the therapist-patient relationship and the patient.
Factors dependent on the disease
- Higher adherence if: symptoms of acute onset, recognizable, annoying and relieved with the treatment.
- Low adherence if: unidentifiable symptoms, maintenance of constant symptoms for a long time, symptoms make it difficult to comply with pre-inscriptions, for example, schizophrenia.
Treatment-dependent factors
- Less adhesion if: complex treatment, interferes with the patient's lifestyle, is durable and is not over-treated.
Therapist-patient variables:
- Good communication and maintenance of a respectful and cordial relationship aimed at improving the degree of understanding and collaboration of the patient in the treatment program.
The importance of good communication
Communication is necessary and doctors often provide less information than necessary, and patients often misunderstand the information they receive.
There are data that ensure that only 50% of the information they receive in consultation is remembered, and between 30% and 50% are misunderstood. On the other hand, more than 80% of patients want more information than they have and are dissatisfied with the one received.
Emphasis should be placed on Give information about what to do, how to do it and when. In addition, the patient's lifestyle should be taken into account when prescribing the treatment, that is, individualising the treatment.
On the other hand it would be convenient for physicians to provide feedback Adequate on the problems that may arise, as well as to test the required behaviors, especially when they are new or complicated and to supervise.
How does the therapist's attitude have to be?
As for the attitudes of the therapist, it is necessary to maintain an empathic attitude and of help and collaboration. The effectiveness of this cordial treatment is associated to the practical repercussion that the patient has on this relationship, that is, to offer simple, accurate and operative information of the tasks that the patient must perform, to adapt the treatment to their rhythm of life, to facilitate The memory of the prescriptions.
What role does the patient have?
Finally, in relation to the variables of the patient, it is true that they are those that have less value as predictors associated with adhesion. In particular, sociodemographic variables do not determine adherence and those related to personality have not proved to be highly influential.
However, those related to the patient's expectations about the disease do, although correlations are low.
Related to this concept is the Self-efficacy , Which refers to the person's conviction of being able to successfully perform the behavior required to produce certain results. The expectations of effectiveness are proposed as a fundamental determinant in the choice of activities. However, this self-efficacy is graded according to the difficulty of the task.
CONCLUSIONS
To finalize this article I leave you some of the strategies that would be effective for the improvement of the adhesion.
- information : Simplify the guideline as much as possible and provide the patient with clear indications about the prescribed therapeutic regimen.
- Reminders : Prescribe medication adapted to the daily activities of the patient, remember the importance of adherence at each visit, adjust the frequency of visits to the patient's needs, call the patient if he does not attend the scheduled visit and send sms.
- Awards : Recognize the efforts made by the patient at each visit to improve adherence and reduce the number of visits if adherence is adequate.
- Social support : Involve family and friends.
Bibliography
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- Basic elements of the approach of the medication in the chronic patient: information to the patient, conciliation, revision and adherence. Barcelona: SEFAP; 2012. Available at: http://www.sefap.org.
- Ballester, R. (2002). Therapeutic adherence: Historical review and state of the art in HIV / AIDS infection. Journal of psychopathology and clinical psychology, vol. 7, no. 3. pag 151-175.
- MannNC: Improving adherence behavior with treatment regimens. Behavioral science learning modules. QUIEN. Div. Mental Health. Geneva, 1993: 1-17.
- Roure C, Gorgas MQ, Delgado O, coord. Guide for the implantation of programs of conciliation of the medication in the health centers. [S.l.]: Catalan Society of Clinical Pharmacy; 2009.