Abstract
Improved understanding of multimorbidity (MM) treatment adherence in primary health care (PHC) in Brazil is needed to achieve better healthcare and service outcomes. This study explored experiences of healthcare providers (HCP) and primary care patients (PCP) with mental-physical MM treatment adherence. Adults PCP with mental-physical MM and their primary care and community mental health care providers were recruited through maximum variation sampling from nine cities in São Paulo State, Southeast of Brazil. Experiences across quality domains of the Primary Care Assessment Tool-Brazil were explored through semi-structured in-depth interviews with 19 PCP and 62 HCP, conducted between April 2016 and April 2017. Through thematic conent analysis ten meta-themes concerning treatment adherence were developed: 1) variability and accessibility of treatment options available through PHC; 2) importance of coming to terms with a disease for treatment initation; 3) importance of person-centred communication for treatment initiation and maintenance; 4) information sources about received medication; 5) monitoring medication adherence; 6) taking medication unsafely; 7) perceived reasons for medication non-adherence; 8) most challenging health behavior change goals; 9) main motives for initiation or maintenance of treatment; 10) methods deployed to improve treatment adherence. Our analysis has advanced the understanding of complexity inherent to treatment adherence in mental-physical MM and revealed opportunities for improvement and specific solutions to effect adherence in Brazil. Our findings can inform research efforts to transform MM care through optimization.
Highlights
Multimorbidity (MM), defined as the co-existence of at least two chronic physical or mental health conditions in a single individual, is a growing global health concern [1]
We report here findings on treatment adherence in a population with mental-physical MM, collected through a large qualitative study, involving in-depth semi-structured interviews with primary care patients (PCP) and healthcare providers (HCP) in primary health care (PHC) and mental health community settings of the XIII Regional Health Department (RHD-13) of São Paulo State, Southeast of Brazil
We focused on variation across participant groups (PCP and four HCP groups), type of healthcare unit (FHS, Basic Health Unit” (BHU) and community mental health service) and municipality size
Summary
Multimorbidity (MM), defined as the co-existence of at least two chronic physical (communicable or non-communicable) or mental health conditions in a single individual, is a growing global health concern [1]. Management of these conditions is fundamental to minimize their impact, improve health outcomes, prevent further disability, and reduce healthcare costs [2]. Treatment adherence, referred to as the extent to which a person is able to follow the agreed recommendations from their health care provider (e.g., taking medication, following a diet, and/or executing lifestyle changes), is a key component of chronic condition management [3]. Non-adherence is a major problem in MM as it can lead to adverse health outcomes, increased healthcare expenditure, and even increased risk of death [10,11,12,13,14,15,16]; according to the World Health Organization “increasing adherence may have a greater effect on health than any improvement in specific medical treatments” [3]
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