1. Introduction
Adherence to pharmacological treatment constitutes a primary concern in regular clinical follow-up of patients with chronic diseases given the impact it has on disease control and increased morbimortality. Various studies [1,2,3,4,5], as well as the World Health Organization [6] (WHO), have concluded that medication nonadherence leads to suboptimal clinical results, increased morbidity and mortality rates, and increased healthcare costs. Between approximately 50% and 60% of patients demonstrate poor medication adherence, especially those with chronic diseases. Consequently, 30% of hospital admissions are related to poor adherence [7,8]. By way of example, the results of a meta-analysis [5] of 21 studies (46,847 participants) showed that good adherence was associated with lower mortality as compared to poor adherence (odds ratio 0.56, 95% confidence interval 0.50 to 0.63). Similarly, a study conducted by Ho et al. on patients with diabetes showed that medication nonadherence was associated with higher rates of all-cause hospitalization and all-cause mortality (23.2% vs. 19.2%, p = 0.001 and 5.9% vs. 4.0%, p = 0.001, respectively) [4].
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In response to this situation, in 2003, the WHO [6] published the following definition of adherence according to characterizations by Haynes and Rand [9]: “the extent to which a person’s behavior—taking medication, following a diet, and/or executing lifestyle changes—corresponds with agreed recommendations from a healthcare provider.” Along these lines, in 2011 Vrijens [10] published a new taxonomy for describing and defining medication adherence, in which adherence was defined as “the process by which patients take their medication as prescribed, further divided into three quantifiable phases: ‘initiation’, ‘implementation’ and ‘discontinuation’”. This definition implies cooperation between prescriber and patient. The term “adherence”, thus, differs from “compliance” in that the latter entails subordination of the patient to the prescribing doctor’s instructions. The concept of adherence, however, implies a change in perspective, to one in which the patient’s view is taken into account during decision-making. One must bear in mind that the patient’s perspective is crucial to understanding their attitude toward taking medication and, more specifically, toward treatment adherence following consultation [11].
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Terminology aside, it is clear that treatment goals and the benefits linked to prescribed drugs can only be reached if patients are persistent in taking medication over the long term [12,13].
Despite the fact that good treatment adherence is very often crucial to achieving the desired goals or cure for an illness, as of now there is no gold standard for determining nonadherence. Nevertheless, there are multiple tools [14,15] available to determine treatment adherence. These tools come with advantages and disadvantages, mostly due to patient subjectivity when responding to questions. Thus, the general consensus is to use more than one tool to detect nonadherence to pharmacological treatment [16,17,18].
Adherence studies face two significant limitations: firstly, incomplete theory that adequately predicts and explains nonadherence; secondly, inconsistency in the definitions of variables, as well as in the interventions carried out across studies, which, in turn, complicates cross-comparison. In light of these limitations, Helmy et al. [19] initiated a Delphi study to create a guide that promotes quality in clinical research on adherence by reaching a consensus on different variables. By defining these variables, they also aimed to limit the ambiguity that surrounds definitions or criteria used to establish treatment nonadherence.
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Despite limitations to the comparison of effective interventions used to improve adherence, the bibliography [20,21,22] presents predicting factors for nonadherence, which the WHO categorizes into five types: socioeconomic factors, factors associated with the healthcare system, therapy-related factors, disease-related factors, and patient-related factors.
The goal of managing adherence is to achieve better medication use by patients in order to maximize benefits and reduce risks, as demonstrated by studies in which action was taken to improve treatment adherence and resulted in a proven positive association between prescribed treatment and health results [23,24].
With the aim of improving treatment adherence by patients with complex chronic diseases within our sphere of influence, we carried out a descriptive study to obtain information related to detection, recording, prevalence, and causes of failure to adhere, according to the healthcare model used for each patient in our primary care practices.
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