Abstract

BackgroundPoor adherence to medication regimens increases adverse outcomes for patients with Type 2 diabetes. Improving medication adherence is a growing priority for clinicians and health care systems. We examine the differences between patient and provider understandings of barriers to medication adherence for Type 2 diabetes patients.MethodsWe searched systematically for empirical qualitative studies on the topic of barriers to medication adherence among Type 2 diabetes patients published between 2002–2013; 86 empirical qualitative studies qualified for inclusion. Following qualitative meta-synthesis methods, we coded and analyzed thematically the findings from studies, integrating and comparing findings across studies to yield a synthetic interpretation and new insights from this body of research.ResultsWe identify 7 categories of barriers: (1) emotional experiences as positive and negative motivators to adherence, (2) intentional non-compliance, (3) patient-provider relationship and communication, (4) information and knowledge, (5) medication administration, (6) social and cultural beliefs, and (7) financial issues. Patients and providers express different understandings of what patients require to improve adherence. Health beliefs, life context and lay understandings all inform patients’ accounts. They describe barriers in terms of difficulties adapting medication regimens to their lifestyles and daily routines. In contrast, providers' understandings of patients poor medication adherence behaviors focus on patients’ presumed needs for more information about the physiological and biomedical aspect of diabetes.ConclusionsThis study highlights key discrepancies between patients’ and providers’ understandings of barriers to medication adherence. These misunderstandings span the many cultural and care contexts represented by 86 qualitative studies. Counseling and interventions aimed at improving medication adherence among Type 2 diabetes might become more effective through better integration of the patient’s perspective and values concerning adherence difficulties and solutions.

Highlights

  • Poor adherence to medication regimens increases adverse outcomes for patients with Type 2 diabetes

  • We provided the methods for the search in detail in a technical report written with the same data on medication adherence among Type 2 diabetes patients for the Ontario Health Technology Advisory Committee’s Expert Advisory Panel [21]

  • Our study shows that patients and providers often agree on the importance of medication adherence for symptom improvement, the benefit of a collaborative and responsive relationship between patient and provider, and effective communication of information

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Summary

Introduction

Poor adherence to medication regimens increases adverse outcomes for patients with Type 2 diabetes. The prevalence of Type 2 diabetes grows steadily, due to environmental and behavioural factors such as economic growth, urbanization, ageing populations, poor dietary habits, and decreased physical activity [4, 5]. Diabetes management targets optimal blood glucose levels, thereby preventing the onset and progression of diabetes-related complications including cardiovascular complications, nerve damage, kidney failure, eye disease, and diabetic foot, all factors that can eventually lead to death [3,4,5]. Effective Type 2 diabetes management can include adherence to medication regimens (hypoglycaemic oral tablets and/or insulin injections), as well as adjustment of specific life-style behaviours, such as increased physical activity, adherence to specific dietary regimens, smoking cessation, and strict monitoring of blood glucose levels [1, 5]

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