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Multidimensional analysis of treatment adherence in patients with multiple chronic conditions. A cross-sectional study in a tertiary hospital

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Title: Multidimensional analysis of treatment adherence in patients with multiple chronic conditions. A cross-sectional study in a tertiary hospital
Authors: Jansà, Margarida1 mjansa@clinic.ub.es, Hernández, Carme2, Vidal, Mercè1, Nuñez, Montse3, Bertran, M. Jesús4, Sanz, Sergi4, Castell, Conxa5, Sanz, Ginés6
Source: Patient Education & Counseling. Nov2010, Vol. 81 Issue 2, p161-168. 8p.
Subject Terms: *Patient education, *Health promotion, Patient compliance, Heart diseases, Drug administration, Chronic disease treatment, Multivariate analysis
Abstract: Objective: Determine treatment adherence in patients with multiple chronic conditions (MCC). Methods: A random patient sample ≥15 years, discharged from hospital with ≥1 chronic conditions (CC) was interviewed after 6–12 months. Analysis included variables in 5 dimensions (WHO): socio-demographics, disease, treatment, patient and health system characteristics. Morisky–Green adherence questionnaire was used. High chronic treatment complexity was defined as: >3 pills/day, >6 inhalations/day, >1 injection/day, pharmacological treatment plus diet or self-monitoring techniques. Results: 301 patients were interviewed (62±15 years, 59% males). Despite good treatment information perception (79%), only 3% followed the patient education programme. Poor adherents (82%) were older (64±14 years vs. 55±16 years), had more CC (3.25±2.02 vs. 2.62±2.72), a higher frequency of hypertension (44% vs. 15%), ischaemic heart diseases: (21% vs. 4%), hyperlipidaemia (19% vs. 6%), more pills/day (5.78±4.14 vs. 3.20±4.70) and more complex treatments (95% vs. 70%) (p <0.05). On multivariate analysis number of CC [3.68 (0.75–18.15)], pills/day [2.23 (1.02–4.84)], treatment complexity [4.00 (1.45–11.04)], and hypertension [2.57 (1.06–6.25)] were predictive of poor adherence (OR 95% CI p <0.05). Conclusion: The WHO conceptual framework allows the construction of poor adherence risk profiles in patients with MCC after hospital discharge. Practice implications: Predictive variables of poor adherence could help clinicians detect patients with MCC most likely to present poor adherence. [Copyright &y& Elsevier]
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Database: Education Research Complete
Description
Abstract:Objective: Determine treatment adherence in patients with multiple chronic conditions (MCC). Methods: A random patient sample ≥15 years, discharged from hospital with ≥1 chronic conditions (CC) was interviewed after 6–12 months. Analysis included variables in 5 dimensions (WHO): socio-demographics, disease, treatment, patient and health system characteristics. Morisky–Green adherence questionnaire was used. High chronic treatment complexity was defined as: >3 pills/day, >6 inhalations/day, >1 injection/day, pharmacological treatment plus diet or self-monitoring techniques. Results: 301 patients were interviewed (62±15 years, 59% males). Despite good treatment information perception (79%), only 3% followed the patient education programme. Poor adherents (82%) were older (64±14 years vs. 55±16 years), had more CC (3.25±2.02 vs. 2.62±2.72), a higher frequency of hypertension (44% vs. 15%), ischaemic heart diseases: (21% vs. 4%), hyperlipidaemia (19% vs. 6%), more pills/day (5.78±4.14 vs. 3.20±4.70) and more complex treatments (95% vs. 70%) (p <0.05). On multivariate analysis number of CC [3.68 (0.75–18.15)], pills/day [2.23 (1.02–4.84)], treatment complexity [4.00 (1.45–11.04)], and hypertension [2.57 (1.06–6.25)] were predictive of poor adherence (OR 95% CI p <0.05). Conclusion: The WHO conceptual framework allows the construction of poor adherence risk profiles in patients with MCC after hospital discharge. Practice implications: Predictive variables of poor adherence could help clinicians detect patients with MCC most likely to present poor adherence. [Copyright &y& Elsevier]
ISSN:07383991
DOI:10.1016/j.pec.2009.12.012