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.