Understanding Patients’ Adherence-Related Beliefs about Medicines Prescribed for Long-Term Conditions: A Meta-Analytic Review of the Necessity-Concerns Framework
et al. (2013) Understanding Patients' Adherence-Related Beliefs about Medicines Prescribed
for Long-Term Conditions: A Meta-Analytic Review of the Necessity-Concerns Framework. PLoS ONE 8(12): e80633. doi:10.1371/journal.pone.0080633
Understanding Patients' Adherence-Related Beliefs about Medicines Prescribed for Long-Term Conditions: A Meta-Analytic Review of the Necessity-Concerns Framework
Rob Horne 0
Sarah C. E. Chapman 0
Rhian Parham 0
Nick Freemantle 0
Alastair Forbes 0
Vanessa Cooper 0
Yinglin Xia, University of Rochester, United States of America
0 1 Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy , London , United Kingdom , 2 Department of Primary Care and Population Health, University College London , London , United Kingdom , 3 Department of Internal Medicine, University College Hospital , London , United Kingdom
Background: Patients' beliefs about treatment influence treatment engagement and adherence. The Necessity-Concerns Framework postulates that adherence is influenced by implicit judgements of personal need for the treatment (necessity beliefs) and concerns about the potential adverse consequences of taking it. Objective: To assess the utility of the NCF in explaining nonadherence to prescribed medicines. Study eligibility criteria: Studies using the Beliefs about Medicines Questionnaire (BMQ) to examine perceptions of personal necessity for medication and concerns about potential adverse effects, in relation to a measure of adherence to medication. Participants: Patients with long-term conditions. Study appraisal and synthesis methods: Systematic review and meta-analysis of methodological quality was assessed by two independent reviewers. We pooled odds ratios for adherence using random effects models. Results: We identified 3777 studies, of which 94 (N = 25,072) fulfilled the inclusion criteria. Across studies, higher adherence was associated with stronger perceptions of necessity of treatment, OR = 1.742, 95% CI [1.569, 1.934], p,0.0001, and fewer Concerns about treatment, OR = 0.504, 95% CI: [0.450, 0.564], p,0.0001. These relationships remained significant when data were stratified by study size, the country in which the research was conducted and the type of adherence measure used. Limitations: Few prospective longitudinal studies using objective adherence measures were identified. Conclusions: The Necessity-Concerns Framework is a useful conceptual model for understanding patients' perspectives on prescribed medicines. Taking account of patients' necessity beliefs and concerns could enhance the quality of prescribing by helping clinicians to engage patients in treatment decisions and support optimal adherence to appropriate prescriptions.
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Introduction
Prescribing medicines is fundamental to the medical
management of most long-term conditions. However, approximately half
of this medication is not taken as directed, representing a failure to
translate potentially effective treatment into optimal outcomes for
patients and society [1,2]. Where prescriptions are appropriate,
this level of nonadherence has potentially serious consequences,
both for individual patients, in terms of lost opportunities for
health gain with increased morbidity and mortality [3], and for the
health care system, in terms of wasted resources, increased use of
services and hospital admissions [4].
In the absence of a single definitive intervention to address
nonadherence [5], the NICE Medicines Adherence Guidelines
amalgamate insights from trials of interventions and explanatory
studies of nonadherence [1]. They apply a perceptions and
practicalities approach [4] recognising that nonadherence may be
both unintentional and intentional. Unintentional nonadherence
occurs when the patient wants to adhere but is unable to because
they lack capacity or resources. For example, they may not have
understood the instructions, cannot afford copayment costs, or
find it difficult to schedule, administer or remember the treatment.
Intentional nonadherence occurs when the patient decides not to
follow the recommendations. It is best understood in terms of the
perceptual factors (e.g. beliefs and preferences) influencing
motivation to start and continue with treatment.
Prescribing consultations do not occur in a vacuum. Patients
(and prescribers) bring pre-existing beliefs about the illness and
treatment [6,7] which influence the patients evaluation of the
prescription, their adherence and even beneficial [8] or adverse
outcomes [9]. Interventions to optimise adherence tend to be more
effective if they are tailored to the needs of the individual taking
account of the perceptions of the treatment as well as practical
abilities and resources that enable or impede their adherence [10].
Although the perceptual and practical dimensions of adherence
are influenced by the social, cultural, economic and healthcare
system contexts, taking account of the patients beliefs about the
presc (...truncated)