Background
Methods
Study design
The Delphi expert panel
The Delphi rounds
Round 1
Round 2
Round 3
Important scale | Operational feasibility scale | Political feasibility scale |
---|---|---|
1. Not at all important
|
1. Definitely unfeasible
|
1. Definitely politically unfeasible
|
− Unlikely to have impact on non-adherence | − Cannot be implemented | − Politically unacceptable |
− Not at all confident about effectiveness of solution | − Unprecedented allocation of resources would be needed | − Completely unacceptable to the public |
− Basic research needed | ||
2. Slightly important
|
2. Probably unfeasible
|
2. Probably politically unfeasible
|
− Potential for impact on a minority of patients | − Some indication that this cannot be implemented | − Major political obstacles |
− Not very confident about effectiveness of solution | − Large scale increase in available resources would be needed | − Not acceptable to a large proportion of the general public |
− Major research effort needed | ||
3. Somewhat important
|
3. May or may not be implemented
|
3. May or may not be implemented politically
|
− Potential for impact on some patients | − Contradictory evidence that this can be implemented | − Political obstacles |
− Unsure about effectiveness of solution | − Increase in available resources would be needed | − Some indication that this may not be acceptable to a large proportion of the general public |
− Indeterminable research evidence available | ||
4. Very important
|
4. Probably feasible
|
4. Probably politically feasible
|
− Potential for impact on majority of patients | − Some indication that this could be implemented | − Some minor political obstacles |
− Quite confident about effectiveness of solution | − Available resources would have to be supplemented | − Further consideration may have to be given to public reaction, although some evidence exists that the proposed solution may be acceptable |
− Some research still required | ||
5. Extremely important
|
5. Definitely feasible
|
5. Definitely politically feasible
|
− Potential for widespread general impact | − Can be implemented | − No major political obstacles |
− Very confident about effectiveness of solution | − Necessary resources (financial, labour etc) are presently available | − Will be acceptable to the general public |
− No further research required |
Round 4
The consensus meeting
Results
Round 1
Category | Count | % |
---|---|---|
Patient factors - patient behaviour/characteristics | 100 | 20.0 |
Medication factors | 98 | 19.6 |
Patient factors - treatment effects | 66 | 13.2 |
Patient factors - patient beliefs and concerns | 55 | 10.9 |
Clinician factors | 42 | 8.4 |
Meta theories of adherence/ theories of adherence | 42 | 8.4 |
Healthcare organisation factors | 32 | 6.4 |
Patient/clinician interaction | 29 | 5.8 |
Environmental and social/structural factors | 28 | 5.6 |
Disease factors | 9 | 1.8 |
Total | 501 |
Categories | Number | % |
---|---|---|
Themes/theories | 20 | 8.2 |
Consequences for patients | 125 | 51.2 |
Disease consequences
|
54
| |
Medication consequences
|
46
| |
Quality of life/well-being consequences
|
25
| |
Consequences for healthcare professionals | 6 | 2.5 |
Consequences for clinician-patient interaction | 11 | 4.5 |
Consequences for the healthcare system | 62 | 25.4 |
Waste of resources
|
52
| |
Public health risk
|
10
| |
Consequences for society | 20 | 8.2 |
Waste of resources
|
14
| |
Research/industry
|
6
| |
Total | 244 |
Solution Category | Number | % |
---|---|---|
Patient focused solutions | 187 | 54.5 |
Educational/informational
|
107
| |
Medication-related
|
39
| |
Behavioural strategies to eradicate forgetfulness etc.
|
32
| |
Involvement of the social network/caregivers can supportpatients with medication adherence
|
6
| |
Building the patient’s trust in the healthcare professional would improve medication adherence
|
3
| |
Healthcare professional focused solutions | 69 | 20.1 |
Clinician-patient interaction focused solutions | 43 | 12.5 |
Themes/theories relating to solutions | 16 | 4.7 |
Health system solutions | 14 | 4.1 |
Government focused solutions | 14 | 4.1 |
Total | 343 |
Causes of non-adherence to medication
Consequences of non-adherence to medication
Solutions to non-adherence to medication
Round 2
Round 3
Round 4
Policy solutions | Priority rating* | Mean importance♦ | Mean operational feasibility | Mean political feasibility |
---|---|---|---|---|
1. Improve patient education and information when a medication is newly prescribed | 8.92 | 4.47 | 4.39 | 4.50 |
2. Improve patient education and information focused on the patients’ treatment | 8.42 | 4.13 | 4.16 | 4.42 |
3. Improve patient education and information regarding the benefits of adherence to their particular medication(s) | 8.40 | 4.11 | 4.24 | 4.34 |
4. Improve education and training for healthcare professionals about ways of addressing medication non-adherence to drive improvements in clinical practice | 8.32 | 4.42 | 3.86 | 3.93 |
5. The patients' preferences for treatment should be discussed to support medication adherence | 8.27 | 4.32 | 3.89 | 4.00 |
6. Improve education and training for healthcare professionals about patient-centred care | 8.25 | 4.32 | 3.89 | 3.96 |
7. Improve patient education and information about potential side effects or adverse effects and how to manage them | 8.21 | 4.08 | 4.13 | 4.13 |
8. Healthcare professionals should support patients with concerns about or experience of side effects of medication | 8.18 | 4.18 | 3.96 | 4.04 |
9. Improve education and training for healthcare professionals about identifying and assessing medication non-adherence to drive improvements in clinical practice | 8.06 | 4.18 | 3.76 | 4.00 |
10. Ensure patient involvement and a partnership approach, for example in treatment plans and decisions, to support medication adherence for those patients who wish to be involved | 8.05 | 4.32 | 3.66 | 3.79 |
11. Simplify the patients’ medication regimen (e.g., less frequent, modified formulation and/or dosage, tailored to individual need) | 8.05 | 4.16 | 3.82 | 3.96 |
12. Improve education and training for healthcare professionals regarding medication adherence in general | 8.03 | 4.05 | 3.95 | 4.00 |
13. Improve patient education and information to assist the patient to weigh up the benefit and harm of medication | 7.99 | 4.18 | 3.75 | 3.86 |
14. Increase public awareness of the issue of medication adherence | 7.94 | 4.13 | 3.82 | 3.79 |
15. The patients' health- and medication-related beliefs should be discussed between the clinician and the patient to support medication adherence | 7.90 | 4.29 | 3.50 | 3.71 |
16. Healthcare professionals should use reviews of medication to discuss medication adherence with patients | 7.84 | 4.03 | 3.82 | 3.79 |
17. Healthcare professionals should provide the patient with ongoing feedback and support with medication-taking | 7.82 | 4.07 | 3.79 | 3.71 |
18. Stop medication(s) that the patient no longer needs or wants | 7.81 | 4.00 | 3.75 | 3.86 |
19. Ensure a consistent team approach to treatment, in which all members of the healthcare team work together to support medication adherence | 7.61 | 4.21 | 3.18 | 3.61 |
20. Healthcare professionals should adopt a non-judgmental approach to the issue of medication adherence | 7.61 | 4.11 | 3.43 | 3.57 |
21. Build patients’ trust in the healthcare professional to support medication adherence | 7.60 | 4.11 | 3.43 | 3.54 |
22. Information provision should be tailored to the individual preferences or needs of the patient | 7.56 | 4.03 | 3.34 | 3.71 |
23. Governments should implement evidence-based policies about medication adherence | 7.53 | 4.05 | 3.42 | 3.53 |
24. Governments should invest resources/money in medication adherence, particularly regarding education, research, and access to medicines | 7.39 | 4.11 | 3.34 | 3.21 |
25. Healthcare professionals should make sufficient time for the patient, for instance through more frequent contact | 6.79 | 4.00 | 2.76 | 2.82 |
Consensus meeting
Patients benefit when provided with support, education, and information
| |
·
| when a medication is newly prescribed |
·
| focused on the patients’ treatment |
·
| about the benefits of adherence to their particular medication(s) |
·
| about potential side effects or adverse effects and how to manage them |
·
| to assist the patient to weigh up the benefit and harm of medication |
·
| tailored to the individual preferences or needs of the patient |
Healthcare professionals should receive education and training about
| |
·
| patient-centred care |
·
| identifying and assessing medication non-adherence |
·
| ways of addressing medication non-adherence when it is identified |
so that they can:
| |
·
| adopt a non-judgmental approach |
·
| identify medication non-adherence |
·
| provide patients with ongoing feedback and support with medication-taking |
·
| support patients with concerns about, or experience of, side effects of medication |
·
| make sufficient time for the patient, for instance through more frequent, timely contact |
Together, healthcare professionals and patients should
| |
·
| discuss the patients' preferences for treatment |
·
| ensure a partnership approach in decision making and treatment |
·
| discuss the patients' health- and medication-related beliefs |
·
| build the patients’ trust in the healthcare professional |
Regarding medicines
| |
·
| simplify the patients’ medication regimen as appropriate (e.g., less frequent, modified formulation and/or dosage, tailored to individual need) |
·
| stop medication(s) that the patient no longer needs or wants |
Healthcare providers should
| |
·
| promote a team approach, sharing information to deliver consistent adherence support |
·
| prioritise medication adherence support in service, organisation, and systems design |
Governments/healthcare payers should
| |
·
| increase public awareness of medication adherence for all citizens |
·
| develop and implement evidence-based interventions for medication adherence |
·
| provide training and guidance for all healthcare providers so they can deliver effective adherence interventions |
·
| invest in research to identify effective interventions demonstrating value for money |