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To adhere or not, and what we can do to help

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Abstract

Two factors predict treatment outcome, how effective the treatment is and whether the patient takes or follows the treatment plan. As clinicians or scientists, we strive to develop newer and more effective treatments, both pharmacological and non-pharmacological to improve treatment outcome in our patient population. Adherence is the single most modifiable factor associated with treatment outcome, yet how often is the issue of adherence addressed in clinical consultations? The best treatment is rendered useless if not adhered to. Initial adherence rates are low and get worse with time, but methodological difficulties in studies make it difficult to determine both the clinical implication of suboptimal adherence and successful strategies. Further research should apply more rigour to the area of definition and measurement, be sufficiently powered and long term, and measure possible confounders, to allow for an understanding on the link and impact between adherence and clinical outcome. This article reviews some of the main issues with regard to adherence and cost implications of suboptimal adherence and suggests future directions.

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References

  1. Sabaté E (2001) WHO Adherence Meeting Report. Geneva, World Health Organization, Adherence to long term therapies, Policy for Action. http://www.who.int/chp/knowledge/publications/adherencerep.pdf

  2. Hellewell JSE (1998) Antipsychotic tolerability: the attitudes and perceptions of medical professionals, patients and caregivers towards side effects of antipsychotic therapy. Eur Neuropschopharmacol 8:248

    Google Scholar 

  3. American Public Health Association (2004) “Adherence to HIV treatment regimens: recommendations for best practices APHA”

  4. Haynes RB, Montague P, Oliver T, McKibbon KA, Brouwers MC, Kanani R (2001) Interventions for helping patients follow prescriptions for medications. Cochrane Libr (Oxford) 1 (28p) (19 ref 23 bib)

  5. Bangsberg DR, Acosta EP, Gupta R, Guzman D, Riley ED, Harrigan PR, Parkin N, Deeks SG (2006) Adherence-resistance relationships for protease and non-nucleoside reverse transcriptase inhibitors explained by virological fitness. AIDS 20(2):223–231

    Article  CAS  PubMed  Google Scholar 

  6. Bangsberg DR, Hecht F, Charlebois E, Zolopa A, Holodniy M, Sheiner L, Bamberger J, Chesney M, Moss A (2000) Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS Vol 14(4):357–366

    Article  CAS  Google Scholar 

  7. Charach A, Figueroa M, Chen S, Ickowicz A, Schachar R (2006) Stimulant treatment over 5 years: effects on growth. Am Acad Child Adolesc Psychiatry. 45(4):415–21

    Google Scholar 

  8. Weiden P (2002) Adherence to antipsychotic medication: key facts. Schizophrenia Home page 2002. http://www.schizophrenia.com/ami/coping/noncompli.2.htm

  9. Pappadopulos E, Jensen PS, Chait AR, Arnold LE, Swanson JM, Greenhill LL, Hecthman L, Chuang S, Wells KC, Pelham W, Cooper T, Elliott G, Newcorn JH (2009) Medication adherence in the MTA: saliva methylphenidate samples versus parent report and mediating effect of concomitant behavioral treatment. J Am Acad Child Adolesc Psychiatry 48(5):501–510

    Article  PubMed  Google Scholar 

  10. Marcus SC, Durkin M (2011) “Stimulant adherence and academic performance in urban youth with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 50(5):480–489

    Article  PubMed  Google Scholar 

  11. Woldu H, Goldstein T, Sakolsky D, Perel J, Emslie G, Mayes T, Clarke G, Ryan ND, Birmaher B, Wagner KD, Asarnow JR, Keller MB, Brent D (2011) Pharmacokinetically and clinician-determined adherence to an antidepressant regimen and clinical outcome in the TORIDA trial. J Am Acad Child Adolesc Psychiatry 50(5):490–498

    Article  PubMed  Google Scholar 

  12. Avins A, Pressman A, Ackerson L, Rudd P, Neuhaus J, Vittinghoff E (2010) Placebo adherence and its association with morbidity and mortality in the studies of left ventricular dysfunction. J Gen Intern Med 25(12):1275–1281

    Article  PubMed  Google Scholar 

  13. Weis SE, Slocum PC, Blais FX, King B, Nunn MG, Matney B, Gomez E, Foresman BH (1994) The effect of directly observed therapy on the rates of drug resistance and relapse in tuberculosis. N Engl J Med 330:1179–1184

    Article  CAS  PubMed  Google Scholar 

  14. World Health Organisation (2003) Adherence to long term therapies, evidence for action. http://whqlibdoc.who.int/publications/2003/9241545992.pdf

  15. Haynes RB, Taylor DW, Sackett DL (1979) Compliance in Health care. Johns Hopkins University press, Baltimore

    Google Scholar 

  16. Neil AL, Batterham P, Christensen H, Bennett K, Griffiths KM (2009) Predictors of adherence by adolescents to a cognitive behavior therapy website in school and community-based settings. J Med Internet Res 11(1):e6

    Article  PubMed  Google Scholar 

  17. Demyttenaere K (1998) Noncompliance with antidepressants: who’s to blame? Int Clin Psychopharmacol 13(Suppl 2):S19–S25

    Article  PubMed  Google Scholar 

  18. Peveler R, George C, Kinmonth A, Campbell M, Thompson C (1999) Effect of antidepressant drug counselling and information leaflets on adherence to drug treatment in primary care: randomised controlled trial. Br Med J 319:612–615

    Article  CAS  Google Scholar 

  19. Chacko A, Newcorn, J, Feirsen N, Uderman J (2010) Improving medication adherence in chronic pediatric health conditions; a focus on ADHD in youth. Curr Pharm Des 16(22):2416–2423(8)

    Google Scholar 

  20. Marcus SC, Wan GJ, Kemner JE, Olfson M (2005) Continuity of methylphenidate treatment for attention-deficit hyperactivity disorder. Arch Pediatr Adolesc Med 159(6):572–578

    Article  PubMed  Google Scholar 

  21. Miller AR, Ialonde CE, McGrail KM (2004) Children’s persistence with methylphenidate therapy; a population based study. Can J Psychiatry 49:761–768

    PubMed  Google Scholar 

  22. Devatharshy T, Charach A, Schachar R (2001) Moderators and mediators of long-term adherence to stimulant treatment in children with ADHD J Acad Child Adolesc Psychiatry 40(8):922–928

    Google Scholar 

  23. Fotheringham MSM (1995) Adherence to recommended medical regimens in childhood and adolescence. J Pediatr Child Health 31:72–78

    Article  CAS  Google Scholar 

  24. Brehm JW (1966) A theory of psychological reactance. Academic Press, New York

    Google Scholar 

  25. Bussing R, Koro-Ljungberg ME, Gary (2005) Exploring help-seeking for ADHD symptoms; a mixed methods approach. Har Rev Psychiatry 13:85–101

  26. DiMatteo MR, Haskard KB, Williams SL (2007) Health beliefs, disease severity and patient adherence: a meta-analysis. Med Care 45(6):521–528

    Article  PubMed  Google Scholar 

  27. Christensen L, Sasane R, Hodgkins P (2010) Pharmacological treatment patterns among patients with attention-deficit/hyperactivity disorder retrospective claims-based analysis of a managed care population. Curr Med Res Opin 26:977–89

    Google Scholar 

  28. Adler, LD, Nierenberg AA (2010) Review of medication adherence in children and adults with ADHD. Postgrad Med 122(1):184–91

    Google Scholar 

  29. Gau SF, Shen H, Chow M (2006) Determinants of adherence to methylphenidate and the impact of poor adherence on maternal and family measures. J Child Adolesc Psychopharm 16:286–297

    Article  Google Scholar 

  30. Gonzalez JS (2007) Physical symptoms, beliefs about medications, negative mood, and long-term HIV medication adherence. Ann Behav Med 34(1):46–55

    Article  PubMed  Google Scholar 

  31. Hall JA, Roter DL, Katz NR (1988) Meta-analysis of correlates of provider behaviour in medical encounters. Med Care 26:657–675

    Article  CAS  PubMed  Google Scholar 

  32. Schulman BA (1979) Active patient orientation and outcomes in hypertensive treatment: application of a socio-organizational perspective. Med Care 17:267–280

    Article  CAS  PubMed  Google Scholar 

  33. Dunbar J, Agras W (1980) Compliance with medical instructions. In: Ferguson J, Taylor C (eds) The comprehensive handbook of behavioural medicine. Springer, New York, pp 115–145

    Chapter  Google Scholar 

  34. Zolnierek KB, Dimatteo MR (2009) Physician communication and patient adherence to treatment: a meta-analysis. Med Care 47(8):826–834

    Article  PubMed  Google Scholar 

  35. Vermeire EIJJ, Wens J, Van Royen P, Biot Y, Hearnshaw H, Lindenmeyer A (2005) Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus. Cochrane Database Syst Rev Issue 2. Art. No.: CD003638. doi:10.1002/14651858.CD003638.pub2

  36. Haynes, RB, Ackloo, E, Sahota N, McDonald HP, Yao X (2008) Interventions for enhancing medication adherence Cochrane Database Syst Rev Issue 2. Art No: CD0000011. doi:10.1002/14651858.CD000011.pub3

  37. Fishbein M, Triandis H, Kanfer F (2001) Factors influencing behaviour and behaviour change. In: Baum A, Revenson T, Sing J (eds) Handbook of health psychology. Erlbaum, Mahway

    Google Scholar 

  38. Prochaska JO, DiClemente CC, Norcross JC (1992) In search of how people change. Applications to addictive behaviors. Am Psychol 47:1102–1114

    Article  CAS  PubMed  Google Scholar 

  39. Ref http://www.motivationalinterview.org/

  40. http://www.motivationalinterview.org/quick_links/mitraining.html

  41. http://www.leedspft.nhs.uk/professionals/lautraining/shortcourses

  42. Leininger MM, McFarland MR (2006) In: Culture care diversity and universality a worldwide nursing theory, 2nd edn. Jones and Bartlett Publishers, Boston

  43. Corrigan PW, Penn DL (1999) Lessons from social psychology on discrediting psychiatric stigma. Am Psychol 54:765–776

    Google Scholar 

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  1. Our Lady’s Children’s Hospital, Dublin, Ireland

    F. McNicholas

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  1. F. McNicholas
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McNicholas, F. To adhere or not, and what we can do to help. Eur Child Adolesc Psychiatry 21, 657–663 (2012). https://doi.org/10.1007/s00787-012-0304-7

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