Making patients follow their treatments is a complex process influenced by multiple factors related to the patient, the disease, the treatment itself, the environment, and the doctor or health professionals.
In this situation, the doctor can help improve the patient’s adherence to treatment, following the appropriate strategy to address the several factors that influence the lack of adherence in each case.
What factors influence the lack of treatment adherence?
We divided these factors into five dimensions:
1. Socioeconomic factors
It highlights the importance of family or social support for the patient. Patients who have good emotional support from their environment or are part of a cohesive family have better adherence to treatment. Likewise, the cost of treatment, lack of insurance coverage, belonging to a lower social class, or having economic problems, have been described as negative factors for treatment adherence. Lack of access to health care can also be a significant barrier to completing treatment. Working patients may have work schedules that interfere with the health facility hours.
2. Factors related to the health system
One of the most influential factors within this category is the professional doctor-patient relationship. Poor communication between both parties, lack of trust, dissatisfaction with the care received, or insufficient information about their treatment or pathology could negatively influence treatment adherence.
The shortage of staff also contributes to delays in care, decreased care time per patient, and rejection of the service provided. It should also be considered that in the case of patients with more complex pathologies, the support of services and specialists that some health establishments may not have, is required. The patient must find and travel to many different places for their requested controls and tests, which can generate fatigue and, consequently, non-compliance with said controls or examinations.
On the other hand, some patients may have a poor relationship with the health team. When patients and health workers do not establish a relationship based on respect and trust, this inadequate relationship can influence patient adherence. If a patient believes and trusts the health worker, that person is more likely to follow instructions and advice to cooperate with their health worker. Patients are also more likely to ask questions and raise concerns about treatment.
3. Treatment-Related Factors
The appearance of adverse effects or treatments with complex guidelines can compromise adherence. In general, prolonged duration of treatment highly influences the patient’s lack of adherence. Having many concurrent controls can also influence treatment adherence.
4. Factors related to pathology
The severity of the pathology, its prognosis, or the impact it may have on the quality of life can also modify the patient’s behavior towards the treatment. The absence of symptoms or the improvement of pain can be a barrier to having a correct adherence to treatment. Once patients no longer feel acute pain after their first consultations, they may believe it is okay to discontinue treatment. In general, when there is a worsening of symptoms or when the disease causes a certain degree of disability, therapeutic adherence is positively affected. However, it is important to not let the pathology get that far and constantly try to make the patients adhere to their treatments.
5. Patient-related factors
In general, the younger the patient, the lower the treatment adherence. The patient’s knowledge of the disease, beliefs and the patient’s personality also influence the adherence.
One of the main consequences of incorrect therapeutic adherence is the lack of knowledge and understanding. Sometimes there are certain topics that patients do not fully understand: the pathology process and its treatment, prevention, how to follow the treatment, control tests, and the reasons why the duration of treatment can be so long. That is why it is not only important to guide the patient, but to do it with simple words and other methods that facilitate their understanding. This lack of knowledge and understanding can lead to an inability or lack of motivation to complete treatment.
Strategies to improve non-adherence
In general, they can be grouped into the following categories:
Technical: Normally aimed at simplifying the treatment regimen, reducing the frequency of controls, providing simple instructions for the various stages of the treatment, etc.
Behavioral: The most common way to improve is to provide the patient with reminders or memory aids (through telephone calls, messages, or email), basic brochures that can be placed at home to remind them of the treatment process, etc.
Another type of intervention consists of monitoring the frequency of controls carried out through compliance calendars where it is noted that the health facility has been visited, where rewards could be offered in case of compliance with the treatment, etc.
Educational: Easy to understand didactic approaches aimed at the patient voluntarily adopting a positive attitude towards treatment by increasing their knowledge about their disease, treatment, and the importance of adherence to it.
Social and family support: The interventions included in this group aim to improve adherence through good social support and the involvement of family or friends in the control of the disease and medication. Such as home or virtual consultation programs, as far as the treatment allows, where family members or friends of the patient participate, etc.
Economic: Provide cheaper options to patients who do not have health insurance that covers their treatment or who have financial difficulties in following the treatment.
Aimed at doctors, administration, and health providers: Conduct educational programs on communication and teaching techniques or behavioral strategies normally based on remembering the need to address preventive measures with patients. For administrative personnel, starting with the front desk, a good option is to take courses where soft skills, the importance of customer service, and medical terminology are trained since they are the first contact of the patient where the influence on the treatment adherence begins.
Given the multifactorial origin of nonadherence, there is no single strategy that has been effective for all patients and all diseases. Thus, the strategies that have shown greater efficacy combine two or more of these interventions.
In addition, it is necessary to personalize the interventions aimed at improving adherence based on the factors involved in the non-compliance of the individual characteristics of the patient.
Check our blog on how to engage with your patients for more tips.
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