Abstract
Background: Adherence to therapy is one of the most important elements during the therapeutic process ensuring the predefined therapeutic outcomes. The aim is to analyze the need and importance of treatment adherence guideline for acromegaly patients and the possibilities for its development and implementation in Bulgaria.Methods: A set of methods was applied: (1) a literature review in the electronic database for identification of articles and guidelines related to adherence and acromegaly; (2) analysis of Bulgarian legislative documents; (3) a pilot study for assessment of the level of treatment adherence among hospitalized Bulgarian acromegaly patients in 2018; (4) a plan for development and implementation of specific guideline was created entitled BULMEDACRO - BULgarian guideline for MEdication aDherence assessment and improvement in ACROmegaly.Results: No specific guidelines for evaluation, monitoring, reporting and/or improving adherence in acromegaly patients has been found in the literature. Requirements for regular assessment of the level of adherence, application of appropriate methods for improvement and monitoring are not sufficiently formulated and mandatory. The pilot study confirmed that therapy adherence among Bulgarian patients with acromegaly is relatively high as almost 90% of patients report that they strictly comply with their prescribed treatment regimen. It is necessary, however, a specific guideline focused on the methods for assessment and improvement of adherence, in order to ensure monitoring and follow-up of acromegaly patients.Conclusions: Patients with acromegaly should be the focus of specially designed national programs, initiatives and/or guidelines for regular evaluation and improvement of the adherence level. Despite the difficulties and the lack of an adequate legal basis, successive steps initiated by different stakeholder are needed.
Highlights
And long-term use of prescribed therapy as recommended by the medical specialists is the key to effective control, especially in chronic diseases
We identified that the number of studies assessing the level of adherence, consent and persistence to the therapeutic regimen among patients with acromegaly is limited [9]
Several documents adopted in Bulgaria were analyzed for requirements related to adherence assessment and tools for adherence improvement: Good Pharmacy Practice (2020) [12], Good Healthcare Professionals Practice (2020) [13], Good Medical Practice (2013) [14], National Health Strategy 2020 [15], project of National Health Strategy 2021–2030 [16], Pharmacotherapeutic guideline for treatment of endocrinology diseases approved by National Council on Pricing and reimbursement of medicinal products, annex of Regulation No 16 21.11.2019, Ordinance on the terms, rules and procedure for regulation and registration of prices for medicinal products, 2013 [17], Law on the medicinal products in human medicine, 2007 [18] and National Health Insurance Fund requirements for treatment of acromegaly in ambulatory settings [19]
Summary
And long-term use of prescribed therapy as recommended by the medical specialists is the key to effective control, especially in chronic diseases. A number of studies show that medicines are often not used as prescribed, leading to poor clinical outcomes and higher health care costs. Addressing the problems with non-adherence to therapy can improve the quality of health care, support better control of chronic diseases, improve therapeutic outcomes and generally reduce the social and economic burden of disease. A recent study pointed out the need for a specific instruments to assure the medication adherence among patients with non-communicable and other chronic diseases during COVID-19 outbreaks [3].
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