Adherence is define as the extent to which patients follow the instructions they are given for prescribed treatments (Haynes et al, 2008). The adherence to chronic medication is not the best as we wish in many therapeutic areas. Non-adherence is associated to adverse clinical outcomes in some chronic conditions.
The reasons for non-adherence (Haynes et al, 2008) could be:
- Side effects
- Poor instructions
- Poor provider-patient relationship,
- Poor memory
- Patients’ disagreement with the need for treatment
- Inability to pay for it
In fact, in Portugal during last years the report from the Portuguese Observatory for the Health Systems (OPPS, 2013) as show that 13,26% of patients as stopped taking the medication and 15,80% claimed to have started to space doses to save money.
It could be very dificult to monitor adherence in those patient, especially the ones with chronic diseases like Chronic Obstructive Pulmonary Disease (COPD). The economical part of the problem (e.g. lack of money to buy the medication) can not be solved with the telemonitoring in COPD, but it can help in other areas.
A telemonitoring system that relies on a Clinical Call Center, so therefore I say: “Real people looking for the data and caring for the patient”, can detect those situations, like: poor instructions and poor memory. The Clinical Call Center (that is a team of nurses, allied health professionals and pharmacists) can handle the non-adherent patients, report to their physician and support the patient for the importance of taking their medicines as prescribed. I can go a little off topic and say that even when the patient as the right prescription and gets their medication at the pharmacy, sometimes he misunderstoods the dose or the number of times that as to take it. Where again the role of the Clinical Call Center is very important to identify those issues.
So, telemonitoring bio-signals is excelent in COPD but it must have a Clinical Call Center to look for the data and clinical alerts, but also to support patients in adherence to the medication.
- Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000011. doi: 10.1002/14651858.CD000011.pub3. Review. Update in: Cochrane Database Syst Rev. 2014;11:CD000011. PubMed PMID: 18425859.
- OBSERVATÓRIO PORTUGUÊS DOS SISTEMAS DE SAÚDE (OPSS) – Duas faces da saúde: relatório da primavera 2013. Coimbra: Observatório Português dos Sistemas de Saúde, 2013.