DiMatteo R; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1973.
University of California, Psychology, 900 University Avenue, Riverside, CA 92508 Tel. 909.787.5734 Fax 909.787.3985
RESEARCH OBJECTIVE: A major limiting factor in the success of chronic care delivery involves the reluctance of patients to accept and follow through with recommendations from their physicians and other health professionals. The literature on patient adherence is very extensive, and although only about 10 percent of the published papers on this topic are empirical articles, there are over 1000 studies. Summarizing what we currently know about the causes and consequences of nonadherence requires an analysis of the entire adherence literature, and the building of data-driven models from meta-analyses. Issues of measurement are critically important, as well. Researchers and clinicians have devised various strategies for assessing patient adherence, yet how these methods relate to each other, whether they over- or under-estimate adherence, and how various factors affect adherence research results need to be examined. STUDY DESIGN: This paper presents a coherent, data-driven model of the results of multiple meta-analyses of the entire literature on predictors, outcomes, and measurement of patient adherence to chronic disease regimens. Moderating variables included definitions of adherence, specific regimens and diseases of concern, and methods of adherence measurement. POPULATION STUDIED: All empirical articles on adherence published in peer-reviewed, English language journals from 1948 through 2002 were included. Studies examined adherence to exercise, diet, medication, health related behavior, screening, vaccination, and appointments (prescribed by a nonpsychiatrist physician). Each article was coded according to: recency, disease condition of patient sample; illness severity and health status; type of adherence measurement method; type of treatment or recommendation requiring adherence; operational definition of adherence; sample size; percentage of patients adhering for each method of adherence assessment, and r (correlation) effect size between methods of adherence assessment, as well as between adherence and the following variables: physician humanistic and communication skill, patient beliefs, anxiety, depression, practical and emotional social support, family cohesiveness, and family conflict, and the outcome of medical treatment PRINCIPAL FINDINGS: Adherence to treatment relates significantly to treatment outcomes. Adherence is positively predicted by physician humanism, and by patients efficacy beliefs, family cohesiveness, and social support. Adherence is negatively predicted by family conflict and patient depression. CONCLUSIONS: The strong effects in this research suggest that in the context of limited resources, patient adherence to chronic disease regimens can best be achieved by improving health professional-patient communication and by insuring that patients believe in the necessity and efficacy of treatment, and have adequate support for adherence. Screening for, and reducing, patient depression and family conflict likely can improve patient adherence. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Estimates suggest that nonadherence costs the US health care system several hundred billion dollars per year. Interventions to improve adherence should be targeted to factors that are known, from quantitative reviews of adherence research, to relate to adherence with strong effects sizes.
Publication Types:
Keywords:
- Biomedical Research
- Chronic Disease
- Communication
- Family
- Health Status
- Humans
- Research Design
- Social Support
- Treatment Outcome
- methods
- hsrmtgs
UI: 103625007
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