Adherence

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Adherence (Engl. For compliance, follow ) in English according to the Latin origin (of adhaerere = append ) adherence, describes the extent to which a person's behavior, such as taking medication, dieting, or changing lifestyle, is consistent with the recommendations agreed with the therapist. The basis of a successful therapy is - according to this view - the consideration of the individual needs of the patient as well as the consideration of factors that make it difficult for the patient to achieve the therapy goal. Good adherence corresponds to consistently following the treatment plan agreed with the therapist. According to the World Health Organization (WHO), on average only 50% of patients achieve good adherence. Adherence to the taking of medication, following a diet or changing lifestyle is particularly important in the chronically ill. In many therapy areas with chronic diseases, after one year only about 50% of the patients are on the initial therapy.

Adherence has a wider significance in antimicrobial and antiviral therapy, for example in HIV therapy. In this case, a lack of adherence can not only lead to individual therapy failure, but also to resistance of the pathogens to drugs.

Factors Affecting Adherence

In 2003 the WHO described five dimensions that influence drug adherence:

Social economy

The following have significant influences on adherence: low socio-economic status, poverty, illiteracy, low level of education, unemployment, a lack of supportive social networks, unstable living conditions, great distance to medical care facilities, high travel costs, high drug costs, cultural perception of an illness and its treatment.

Belonging to a certain ethnic group is often described as an influencing factor, this is most likely to be associated with different cultural beliefs and social differences.

War is also often cited as an influencing factor; even if this has ended, its after-effects will continue to affect adherence for a long time.

Age is another factor. However, it seems that it sometimes occurs with a significant difference in scope and must therefore always be considered separately.

Health system

A good patient-caregiver relationship can have a positive effect on adherence.

Negative effects result from: poorly developed health systems, poor drug distribution / accessibility, lack of knowledge and experience of the caregivers in dealing with chronic diseases, overworked caregivers, short office hours, lack of opportunities to provide patients with targeted information and care, inability to establish self-help groups and promote self-management.

illness

These factors work in conjunction with the severity of the symptoms, the extent of the disability (physical, psychological, social and professional), the nature and severity of the disease process and the availability of effective therapy. Additional illnesses such as depression, Alzheimer's or addiction to intoxicants have an additional influence on adherence.

therapy

The following have a significantly negative influence on adherence: complex drug regimen, duration of treatment, no rapid treatment success, side effects (and their treatability), previously unsuccessful therapies.

Patient

These factors relate to the patient's resources, knowledge, attitude, belief, imagination and expectation. The influences on adherence have not been fully established and are still being researched and discussed. Some factors that could be brought into connection with adherence are: forgetfulness, psychosocial stress, fear of side effects, low motivation, poor knowledge and ability to deal with side effects, pessimism towards therapy, lack of acceptance of the disease, fear of dependence, Therapeutic instructions not understood, bad experiences with people from the health system, the feeling of stigma from the illness.

Adherence vs. Compliance

The term adherence is increasingly replacing the term compliance (English for consent, compliance, compliance, docility ) in medicine. Closely defined, compliance means “the extent to which a patient follows medical instructions” (WHO report 2003). This describes the patient's compliance with the therapy guidelines and represents an outdated view, according to which the responsibility for a therapy success or therapy failure lies unilaterally with the patient. In addition, the term compliance implies that therapy success can only be guaranteed if the prescribed therapy is adhered to precisely and without criticism, and the individual problems and possibilities of the patient when prescribing and performing the therapy can be disregarded. However, the current state of nursing science requires the patient to be included in the design of the therapy, particularly with the support of individual self-care management. Therefore, the concept of adherence is becoming increasingly important.

Methods of measuring adherence

Common methods for determining adherence in studies and for monitoring the course of therapy are: electronic monitoring, patient self-assessment with questionnaires, "pill count" and determination of the drug level in the blood. The most accurate values ​​are likely to be achieved through electronic monitoring. Electronic devices are used here to record when the drug box is opened. The disadvantage, however, are the high costs and the need to instruct the patient in its use. The latter can lead to an underestimation of the adherence. The “pill count” counts the tablets that the patient has not yet taken. Adherence is calculated according to the formula (total of tablets dispensed - total of tablets returned) / total of tablets prescribed and expressed as a percentage. The exact time of ingestion cannot be determined with this method, and the adherence values ​​seem to be methodologically somewhat increased. The patient survey is the most common method for determining adherence. However, patients seem to overestimate their adherence and the information for longer periods of time quickly becomes inaccurate. More precise values ​​can be achieved by determining the medication in the blood. However, this method is costly and only provides information about the period in which the substance has not yet been excreted or metabolized.

Importance of adherence to HIV drugs

Due to the high rate of mutation and the versatility of the HI virus , regular intake of antiviral drugs is essential for suppressing virus replication and preventing the formation of resistance. The consequences of irregular medication intake can have serious consequences for the patient: The viral load increases and leads to a weakening of the immune system (decrease in CD4 + cells). Permanently low adherence can therefore lead to the manifestation of AIDS . An increase in the viral load also increases the risk of infection. Potentially occurring drug resistance makes the use of other drugs necessary: ​​The therapy is usually more expensive and because of the high number of tablets also a greater burden for the patient. Since resistances are also transferable, the adherence of the individual can also have consequences for the future therapy of many people. It is assumed that adherence of at least 95% is necessary for maximum suppression of the virus. According to studies , between 47% and 79% of patients take more than 95% of their antiretroviral drugs - depending on the measurement method and the patient population.

Other meanings of terms

As adherence or adhesion also is the adhesion of bacteria to cell wall or extracellular matrix structures by means of so-called. Adhesins called.

The formation of cell-cell contacts through cell adhesion proteins is also referred to as adherence . In the hematopoietic system , leukocytes , for example, adhere to one another, but also to blood vessel walls (endothelia) and other cells of the organism.

Web links

Individual evidence

  1. a b c d e f Sabaté, E., WHO Adherence to Long Term Therapies Project., Global Adherence Interdisciplinary Network., & World Health Organization. Dept. of Management of Noncommunicable Diseases. (2003). Adherence to long-term therapies: evidence for action. Geneva: World Health Organization.
  2. Morgan, M., & Watkins, CJ (1988). Managing hypertension: beliefs and responses to medication among cultural groups. Sociology of Health & Illness, 10 (4), 561-578.
  3. Schwalm, D. (1997). Series: Illness and war: A varied relationship. Reports from Lebanon: Effects of war on compliance (Vol. 20). Berlin, ALLEMAGNE: Science & Education.
  4. LE Rose, MT Kim, CR Dennison, MN Hill: The contexts of adherence for African Americans with high blood pressure. In: Journal of advanced nursing. Volume 32, Number 3, September 2000, pp. 587-594, PMID 11012800 .
  5. PS Ciechanowski, WJ Katon, JE Russo: Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. In: Archives of internal medicine. Volume 160, Number 21, November 2000, pp. 3278-3285, PMID 11088090 .
  6. German Network for Quality Development in Nursing (DNQP): Expert standard for the care of people with chronic wounds , Osnabrück 2008.
  7. ^ Fritz H. Kaiser, Erik C. Böttger, Rolf M. Zinkernagel, Otto Haller, Johannes Eckert, Peter Deplazes: pocket textbook medical microbiology; 11th revised and expanded edition, Georg Thieme Verlag, 1969,2005, ISBN 3-13-444811-4 .

See also

Patient-doctor relationship , informed consent