Implications for Understanding Adherence

Numerous studies have been undertaken in an effort to understand who is likely to have adherence difficulties. The results of these studies have shown inconsistent relationships between predictors and adherence (Dunbar-Jacob et al, 2009). Few predictors have been found to be very robust within studies. It is not unreasonable to find inconsistency in the prediction of adherence when we note the variability in the phase of adhering to a treatment and the inconsistency in classification of a person's adherence given the varying methods of defining and assessing adherence. More careful description of the population and its stage of treatment (agreement with treatment, initiation of treatment, adjustment to new treatment, continuation of treatment) as well as clearer descriptions of the definition and assessment methodology will be required before we can begin to understand the predictors of adherence.

Similarly, numerous studies have examined strategies to improve adherence. A meta-analysis by Peterson et al (2003) showed that interventions increased adherence by 4-11%, a very small amount. Kripalani and colleagues (2007) reported that just 54% of studies reviewed reported improvements in adherence while just 30% showed clinical improvements, not always related to adherence. Looking within hypertension care, Schroeder et al (2004) found that 78% of adherence studies which simplified the regimen, 44% of those using complex interventions, and 42% of those using motivational strategies reported improvements in adherence. Adherence improvements ranged from 5 to 41%. However, the heterogeneity in measurement of adherence and methods of study prevented conduct of a pooled analysis. Thus, our knowledge of both intervention strategies and of predictors of adherence is hampered by the variability with which adherence is treated in studies.

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