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      Factors affecting therapeutic compliance: A review from the patient’s perspective

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          Abstract

          Objective

          To explore and evaluate the most common factors causing therapeutic non-compliance.

          Methods

          A qualitative review was undertaken by a literature search of the Medline database from 1970 to 2005 to identify studies evaluating the factors contributing to therapeutic non-compliance.

          Results

          A total of 102 articles was retrieved and used in the review from the 2095 articles identified by the literature review process. From the literature review, it would appear that the definition of therapeutic compliance is adequately resolved. The preliminary evaluation revealed a number of factors that contributed to therapeutic non-compliance. These factors could be categorized to patient-centered factors, therapy-related factors, social and economic factors, healthcare system factors, and disease factors. For some of these factors, the impact on compliance was not unequivocal, but for other factors, the impact was inconsistent and contradictory.

          Conclusion

          There are numerous studies on therapeutic noncompliance over the years. The factors related to compliance may be better categorized as “soft” and “hard” factors as the approach in countering their effects may differ. The review also highlights that the interaction of the various factors has not been studied systematically. Future studies need to address this interaction issue, as this may be crucial to reducing the level of non-compliance in general, and to enhancing the possibility of achieving the desired healthcare outcomes.

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          Most cited references 173

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          Adherence to medication.

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            Adherence to long-term therapies: evidence for action.

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              Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness.

              The aim of this cross-sectional study was to quantify patients' personal beliefs about the necessity of their prescribed medication and their concerns about taking it and to assess relations between beliefs and reported adherence among 324 patients from four chronic illness groups (asthma, renal, cardiac, and oncology). The findings revealed considerable variation in reported adherence and beliefs about medicines within and between illness groups. Most patients (89%) believed that their prescribed medication was necessary for maintaining health. However, over a third had strong concerns about their medication based on beliefs about the dangers of dependence or long-term effects. Beliefs about medicines were related to reported adherence: higher necessity scores correlated with higher reported adherence (r=0.21, n=324, p<0.01) and higher concerns correlated with lower reported adherence (r=0.33, n=324, p<0.01). For 17% of the total sample, concerns scores exceeded necessity scores and these patients reported significantly lower adherence rates (t=-4.28, p<0.001). Stepwise multiple linear regression analysis showed that higher reported adherence rates were associated with higher necessity-concerns difference scores (beta=0.35, p<0.001), a diagnosis of asthma (beta= -0.31, p<0.001), a diagnosis of heart disease (beta=0.19, p<0.001), and age (beta=0.22, p<0.001). Gender, educational experience, or the number of prescribed medicines did not predict reported adherence. Medication beliefs were more powerful predictors of reported adherence than the clinical and sociodemographic factors, accounting for 19% of the explained variance in adherence. These data were consistent with the hypothesis that many patients engage in an implicit cost-benefit analysis in which beliefs about the necessity of their medication are weighed against concerns about the potential adverse effects of taking it and that these beliefs are related to medication adherence.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                February 2008
                February 2008
                : 4
                : 1
                : 269-286
                Affiliations
                [1 ]simpleDepartment of Pharmacy, National University of Singapore Republic of Singapore
                [2 ]simpleDepartment of Clinical Pharmacology and Therapeutics, Yong Loo Lin School of Medicine, National University of Singapore Republic of Singapore
                [3 ]simpleDiscipline of Pharmacy and Experimental Pharmacology, School of Biomedical Sciences, University of Newcastle Callaghan, Australia
                Author notes
                Correspondence: Shu Chuen Li Discipline of Pharmacy and Experimental Pharmacology, School of Biomedical Sciences, University of Newcastle, Callaghan, NSW 2308, Australia Tel +61 2 49215921 Email shuchuen.li@ 123456newcastle.edu.au
                Article
                2503662
                18728716
                © 2008 Dove Medical Press Limited. All rights reserved
                Categories
                Original Research

                Medicine

                patient compliance, factors, adherence

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