References
Medicines adherence in respiratory disease
Abstract
In respiratory diseases, there are good pharmacological and non pharmacological therapeutic interventions that can improve symptoms, health status and quality of life for many, and in some cases transform and even save lives. What is not in place is a robust method for ensuring that the therapies and interventions that are prescribed or advised can and will be taken as instructed, and we call this nonadherence. This article looks at medicines adherence, using examples from respiratory diseases and their treatments, discussing what what is meant by it, the reasons it remains problematic, and what could be done about it in respiratory prescribing
Adherence is the term currently used to describe a patient following prescribed or suggested treatment regimens; in other words – the degree to which a patient correctly follows medical advice (Bell et al, 2007). Adherence was previously, and sometimes concomitantly, known as compliance and concordance, however these terms are not synonymous (Bell et al, 2007). Concordance does not refer to a patient's medicine-taking behaviour, but instead the nature of the interaction between clinician and patient (Bell et al, 2007).
Adherence is regarded as a major problem in all pharmacological interventions, with approximately half of all patients with chronic diseases not adhering to their medical regimens, so is not specific to respiratory diseases (Jungst, 2019).
Commonly, adherence refers to medication or drug compliance, but it also applies to interventions, such as the use of medical devices, self-directed exercise programmes, self-care, self-management, and therapy sessions such as pulmonary rehabilitation. It is known that both the person receiving the advice or prescription and the healthcare provider affect adherence, and it is said that a positive physician-patient relationship is the single most important factor in improving adherence; this finding has been consistent over time (World Health Organization (WHO), 2003; Mathes et al, 2014). The cost of prescription medication may also play a major role in adherence to therapies, although in 2016, 89.4% of prescriptions dispensed in England were free of charge so it is not the whole answer (National Institute of Clinical Excellence (NICE), 2009; NHS Digital, 2016).
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