Table 1 Barriers to good adherence and patient engagement [6–14] and the corresponding interventions
Factors in poor adherence and examples | Interventions for patient support programs |
|---|---|
Intentional factors | |
Fear and experience of side effects The patient has experienced or fears experiencing side effects and thus avoids taking the medication | Explanation and coaching by healthcare professionals (patient empowerment) |
Collaborative care and raised awareness of AIT | |
Lack of perceived efficacy The patient considers that the medication is not “working” and is of no value | Individual patient coaching |
Explanation and coaching by healthcare professionals (patient empowerment) | |
Collaborative care and raised awareness of AIT | |
High perceived efficacy The patient considers that the medication has done its job and can thus be discontinued | Individual patient coaching |
Coaching by healthcare professionals (patient empowerment) | |
Collaborative care and raised awareness of AIT | |
Financial issues The patient considers that he/she can save money by reducing the number of doses or the duration of treatment | Point-of-care cost reduction |
Social issues and lack of convenience The patient is embarrassed to take his/her medication when outside the home setting (for AIT normally administered at home) or fails to renew or collect a prescription due to travel/cost issues | Easy-to-administer formulations |
Patient mentors | |
Explanation and coaching by healthcare professionals (patient empowerment) | |
Psychological factors The patient does not accept that he/she is really ill (denial of the disease), and so not taking the medication helps him/her to think less about the disease | Explanation and coaching by healthcare professionals (patient empowerment) |
Collaborative care and raised awareness of AIT | |
Non-intentional factors | |
Forgetfulness The patient forgets to take his/her medication. Forgetfulness can be accentuated by a number of lifestyle and health-related factors (travel, age, co-morbidities, social activities etc.) | Reminders sent by: telephone (automated or human), text messages, e-mail, social networks, electronic pillboxes. |
Patient mentors | |
Individual patient counselling | |
Poor physician-patient communication and/or poor health literacy The patient does not understand the dosing instructions and/or does not how to resume treatment after interruption | Clearer product information sheets |
Simplified but safe regimens for resumption after interruption | |
Patient mentors | |
Explanation and coaching by healthcare professionals (patient empowerment) | |
Collaborative care and raised awareness of AIT | |
Unscheduled travel or school/work commitments The patient has to travel or change his/her daily routine unexpectedly, which interferes with taking medication | Easy-to-administer formulations |
Reminders sent by: telephone (automated or human), text messages, e-mail, social networks, electronic pillboxes | |
Poor stock management The patient fails to anticipate the need to renew a prescription and therefore runs out of medication | Reminders sent by: telephone (automated or human), text messages, e-mail, social networks, electronic pillboxes |
Individual patient coaching | |