Medication Adherence in Chronic Disease

Abstract

Background: Chronic disease places a substantial health and economic burden on individuals and health systems globally. Effective chronic disease management relies on patient adherence to proven medications. Medication adherence rates in chronic disease are sub-optimal, yet adherence-enhancing intervention results are underwhelming. Potentially, current strategies are not matching patient adherence preferences, nor addressing heterogeneity in adherence behaviour between social groups. To inform effective intervention design, this thesis aimed to explore adherence preferences for chronic disease medications and to investigate the effectiveness of adherence-enhancing strategies in socioeconomically disadvantaged groups. Methods: Two discrete choice experiments (DCEs) and a qualitative study were conducted to explore adherence preferences within Australia. A systematic review exploring the effect of strategies aimed at improving adherence to cardiovascular disease medications in socioeconomically disadvantaged populations was conducted. Results and conclusions: Intentional medication decisions were a product of trading between treatment-related factors, particularly cost, treatment scheduling, medication harms and long-term benefits. A patient’s attitudes towards medications, expectations of prescribers and their social context shaped adherence preferences and behaviour. The findings do not support a one-size-fits-all approach to adherence-enhancing interventions. By accounting for heterogeneity in behaviour and critically addressing patient-perceived safety of medications, significant improvements in adherence within the Australian healthcare setting may be achieved.