TOPIC 6. Strategies to improve therapeutic adherence
Statement 9: Adherence to recommended treatment regimen
is crucial to ensure the effectiveness of therapies. Consequently, it is
important to identify the specific barriers to therapeutic adherence in
CF patients, planning intervention strategies based on specific needs .
All CF experts agreed that it is necessary to sustain therapeutic
adherence which represents a very important factor in achieving
beneficial effects from therapies in CF patients (Figure 5A ).
In final consensus meeting, there was unanimous response to this
statement.
Mucoactive therapies to augment mucociliary clearance and to control
infection and inflammation are prescribed as maintenance therapies to
improve lung function and prevent pulmonary exacerbations. Despite the
benefits of CF treatments, medication adherence among individuals with
CF remains low, ranging from 33% to 76%46-48.
Adherence of CF adults to medication regimens has been documented as
problematic49,50.
Poor adherence to medication is associated with adverse clinical
outcomes in CF51.
Adherence to recommended treatment regimen is influenced by the extent
of treatment burden, having the time to do treatment, having a routine,
forgetting to do therapy, a person’s identity, perceptions of control,
social support, and knowledge and interaction with health
professionals52.
Completely understanding the factors affecting adherence is a crucial
step in the process of developing effective evidence-based behavior
change interventions to support self-management of long-term conditions.
A recent study emphasizes that different people have different issues
affecting adherence including issues of motivation, capability, and
opportunity. Consequently, there is no simple one-size fits all
intervention that can be effective, and clinicians need to be aware of
these differences in order to tailor adherence support
appropriately52.
Statement 10: The motivational interview with patients
could be used to improve therapeutic adherence and, consequently,
disease management .
The expert panel reached a high level of consensus on the use of the
motivational interview as a strategy to enhance adherence in cystic
fibrosis (Figure 5B ). In final consensus meeting, there was
unanimous response to this statement.
In a very complex disease such as cystic fibrosis, the relationship
between patient and health professional is extremely relevant and should
allow for good communication and mutual respect53.
To enhance adherence clinicians should be mindful that in a condition
where treatment burden and time pressures are huge, any interventions
should focus on simplifying care and reducing treatment burden. CF
specialists should establish a supportive, collaborative relationship
with patients and their families. Indeed, open and honest dialogue may
reveal barriers to the adherence, such as financial, psychiatric, or
social stressors that may require referral to a psychologist, or team
social worker for assistance54. Patient-centered,
collaborative approaches to consultations and management are
increasingly being viewed as desirable models of care.
Motivational interviewing (MI) was first described in 1983, as a
patient-centered counseling style developed specifically to help
patients change behavior55. Clinicians and other
healthcare professionals practicing MI support CF patients to explore
discrepancies between beliefs and behaviours and move towards change by
using active listening strategies56,57.