Abstract
BackgroundNon-adherence is widespread problem. Adherence is a crucial point for the success and the safe use of therapies. The objective of this overview (review of reviews) was to identify factors that influence adherence in chronic physical conditions.MethodsA systematic literature search was performed in Medline and Embase (1990 to July 2013). Publications were screened according to predefined inclusion criteria. The study quality was assessed using AMSTAR. Both process steps were carried out independently by two reviewers. Relevant data on study characteristics and results were extracted in piloted standardized tables by one reviewer and checked by a second. Data were synthesized using a standardized quantitative approach by two reviewers.ResultsSeven systematic reviews were included. Higher education and employment seem to have a positive effect on adherence. Ethnic minorities seem to be less adherent. Co-payments and higher medication cost seems to have negative effect on adherence. In contrast financial status/income and marital status seem to have no influence on adherence. The effect of therapy related factors was mostly unclear or had no effect. Only the number of different medications in heart failure patients showed the tendency of an effect. Indicators of regime complexity showed consistently a negative effect direction. Duration of disease seems to have no effect on adherence. There is the tendency that higher or middle age is associated with higher adherence. But in more than half of the reviews the effect was unclear. There is no clear effect of physical as well as mental comorbidity. Only one review showed the tendency of an effect for mental comorbidity. Also for gender the effect is not clear because the effect direction was heterogenic between and within the systematic reviews.ConclusionThe presented overview shows factors than can potentially have influence on adherence. Only for a few factors the influence on adherence was consistent. Most factors showed heterogeneous results regarding statistical significance and/or effect direction. However, belonging to an ethnic minority, unemployment and cost for the patient for their medications showed consistently a negative effect on adherence which indicates that there is a social gradient.Electronic supplementary materialThe online version of this article (doi:10.1186/2049-3258-72-37) contains supplementary material, which is available to authorized users.
Highlights
IntroductionAdherence is a crucial point for the success and the safe use of therapies
Most systematic reviews were excluded because a risk of bias assessment was not performed or the quality of evidence was not attributable to the influencing factors
In chronic malignant pain there is a tendency that education has effect on adherence [11]
Summary
Adherence is a crucial point for the success and the safe use of therapies. The objective of this overview (review of reviews) was to identify factors that influence adherence in chronic physical conditions. Non-adherence is widespread problem in chronic conditions [2,3]. Adherence is a crucial point for the success, and for the safe and effective use of many therapies [4,5,6]. In. Adherence is a multifactorial problem that can be influenced by various factors. The factors can be roughly divided in the following five dimensions: Social and economic, health care system, health condition, therapy and patient [3]. Non-adherence can be intentional (e.g. decided not to take because of adverse events) and non-intentional (e.g. forgetfulness)
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