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| title | chunk | source | category | tags | date_saved | instance |
|---|---|---|---|---|---|---|
| Adherence (medicine) | 4/5 | https://en.wikipedia.org/wiki/Adherence_(medicine) | reference | science, encyclopedia | 2026-05-05T07:25:48.247796+00:00 | kb-cron |
=== Technology === In 2012 it was predicted that as telemedicine technology improves, physicians will have better capabilities to remotely monitor patients in real-time and to communicate recommendations and medication adjustments using personal mobile devices, such as smartphones, rather than waiting until the next office visit. Medication Event Monitoring Systems (MEMS), as in the form of smart medicine bottle tops, smart pharmacy vials or smart blister packages as used in clinical trials and other applications where exact compliance data are required, work without any patient input, and record the time and date the bottle or vial was accessed, or the medication removed from a blister package. The data can be read via proprietary readers, or NFC enabled devices, such as smartphones or tablets. A 2009 study stated that such devices can help improve adherence. More recently a 2016 scoping review suggested that in comparison to MEMS, median mediction adherence was grossly overestimated by 17% using self-report, by 8% using pill count and by 6% using rating as alternative methods for measuring medication adherence. The effectiveness of two-way email communication between health care professionals and their patients has not been adequately assessed.
==== Mobile phones ==== As of 2019, 5.15 billion people, which equates to 67% of the global population, have a mobile device and this number is growing. Mobile phones have been used in healthcare and has fostered its own term, mHealth. They have also played a role in improving adherence to medication. For example, text messaging has been used to remind patients to take medication in patients with chronic conditions such as asthma and hypertension. Other examples include the use of smartphones for synchronous and asynchronous Video Observed Therapy (VOT) as a replacement for the currently resource intensive standard of Directly Observed Therapy (DOT) (recommended by the WHO) for Tuberculosis management. Other mHealth interventions for improving adherence to medication include smartphone applications, voice recognition in interactive phone calls and Telepharmacy. Some results show that the use of mHealth improves adherence to medication and is cost-effective, though some reviews report mixed results. Studies show that using mHealth to improve adherence to medication is feasible and accepted by patients. Specific mobile applications might also support adherence. mHealth interventions have also been used alongside other telehealth interventions such as wearable wireless pill sensors, smart pillboxes and smart inhalers
=== Forms of medication === Depot injections need to be taken less regularly than other forms of medication and a medical professional is involved in the administration of drugs so can increase compliance. Depot's are used for oral contraceptive pill and antipsychotic medication used to treat schizophrenia and bipolar disorder.
=== Coercion === Sometimes drugs are given involuntarily to ensure compliance. This can occur if an individual has been involuntarily committed or are subjected to an outpatient commitment order, where failure to take medication will result in detention and involuntary administration of treatment. This can also occur if a patient is not deemed to have mental capacity to consent to treatment in an informed way.
== Health and disease management == A WHO study estimates that only 50% of patients with chronic diseases in developed countries follow treatment recommendations. Asthma non-compliance (28–70% worldwide) increases the risk of severe asthma attacks requiring preventable ER visits and hospitalisations; compliance issues with asthma can be caused by a variety of reasons including: difficult inhaler use, side effects of medications, and cost of the treatment.
=== Cancer === 200,000 new cases of cancer are diagnosed each year in the UK. One in three adults in the UK will develop cancer that can be life-threatening, and 120,000 people will be killed by their cancer each year. This accounts for 25% of all deaths in the UK. However while 90% of cancer pain can be effectively treated, only 40% of patients adhere to their medicines due to poor understanding. Results of a recent (2016) systematic review found a large proportion of patients struggle to take their oral antineoplastic medications as prescribed. This presents opportunities and challenges for patient education, reviewing and documenting treatment plans, and patient monitoring, especially with the increase in patient cancer treatments at home. The reasons for non-adherence have been given by patients as follows:
The poor quality of information available to them about their treatment A lack of knowledge as to how to raise concerns whilst on medication Concerns about unwanted effects Issues about remembering to take medication Partridge et al (2002) identified evidence to show that adherence rates in cancer treatment are variable, and sometimes surprisingly poor. The following table is a summary of their findings:
Medication event monitoring system - a medication dispenser containing a microchip that records when the container is opened and from Partridge et al (2002) In 1998, trials evaluating Tamoxifen as a preventative agent have shown dropout rates of around one-third:
36% in the Royal Marsden Tamoxifen Chemoprevention Study of 1998 29% in the National Surgical Adjuvant Breast and Bowel Project of 1998 In March 1999, the "Adherence in the International Breast Cancer Intervention Study" evaluating the effect of a daily dose of Tamoxifen for five years in at-risk women aged 35–70 years was
90% after one year 83% after two years 74% after four years
=== Diabetes === Patients with diabetes are at high risk of developing coronary heart disease and usually have related conditions that make their treatment regimens even more complex, such as hypertension, obesity and depression which are also characterised by poor rates of adherence.