Skip to main content
SpringerLink
Log in

Therapieadhärenz in der neurologischen Praxis

Beispiel: Multiple Sklerose

Adherence to neurologic treatment

Lessons from multiple sclerosis

  • Übersichten
  • Published:
Der Nervenarzt Aims and scope Submit manuscript

Zusammenfassung

Was nützt die wirkungsvollste Tablette, wenn der Patient sie nicht nimmt? Diese Frage trifft im Kern eines der weitreichendsten Probleme der modernen Gesundheitsversorgung. Gerade vor dem Hintergrund einer alternden Gesellschaft und einer damit verbundenen Zunahme von chronisch behandlungsbedürftigen Erkrankungen, stellt sich die Frage nach Einflussfaktoren und Interventionsmöglichkeiten bei mangelnder Therapietreue. Suchte man in der Vergangenheit die Ursache für das Adhärenzproblem zunächst ausschließlich beim Patienten, zeigen neue Ansätze, dass es sich bei der Adhärenz viel mehr um ein multikausales Konstrukt handelt, was Interventionen auf vielfältigen Ebenen erfordert. Die vorliegende Arbeit diskutiert das aktuelle Adhärenzproblem in Zahlen und erläutert Folgen und Risiken. Am Beispiel der chronisch-entzündlichen Erkrankung Multiple Sklerose werden spezifische Einflussfaktoren beschrieben und Strategien zur Verbesserung der Adhärenz aufgezeigt.

Summary

In light of increasing prevalence rates of chronic conditions and a growing elderly population, patients’ nonadherence to medical regimes reflects a significant problem in modern health care. In the past, patients were primarily held responsible for problematic adherence. Over the past decades this attitude has changed dramatically, and it is now acknowledged that lack of adherence reflects a problem requiring different approaches and interventions on many different levels. Here we highlight central aspects and consequences of adherence problems in long-term therapy. Factors affecting treatment motivation in multiple sclerosis patients are summarized focusing on neurologic treatment issues, and specific intervention strategies for patients, doctors, and nurses are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Andrejak M, Genes N, Vaur L et al. (2000) Electronic pill-boxes in the evaluation of antihypertensive treatment compliance: comparison of once daily versus twice daily regimen. Am J Hypertens 13: 184–190

    Article  PubMed  CAS  Google Scholar 

  2. Baker DW, Wolf MS, Feinglass J et al. (2007) Health literacy and mortality among elderly persons. Arch Intern Med 167: 1503–1509

    Article  PubMed  Google Scholar 

  3. Bandura A (2004) Health promotion by social cognitive means. Health Educ Behav 31: 143–164

    Article  PubMed  Google Scholar 

  4. Bartlett EE, Grayson M, Barker R et al. (1984) The effects of physician communications skills on patient satisfaction; recall, and adherence. J Chronic Dis 37: 755–764

    Article  PubMed  CAS  Google Scholar 

  5. Bell C, Graham J, Earnshaw S et al. (2007) Cost-effectiveness of four immunomodulatory therapies for relapsing-remitting multiple sclerosis: a Markov model based on long-term clinical data. J Manag Care Pharm 13: 245–261

    PubMed  Google Scholar 

  6. Broderick JE, Arnold D, Kudielka BM et al. (2004) Salivary cortisol sampling compliance: comparison of patients and healthy volunteers. Psychoneuroendocrinology 29: 636–650

    Article  PubMed  CAS  Google Scholar 

  7. Brody DS (1980) Physician recognition of behavioral, psychological, and social aspects of medical care. Arch Intern Med 140: 1286–1289

    Article  PubMed  CAS  Google Scholar 

  8. Chan M, Nicklason F, Vial JH (2001) Adverse drug events as a cause of hospital admission in the elderly. Intern Med J 31: 199–205

    Article  PubMed  CAS  Google Scholar 

  9. Chwastiak L, Ehde DM, Gibbons LE et al. (2002) Depressive symptoms and severity of illness in multiple sclerosis: epidemiologic study of a large community sample. Am J Psychiatry 159: 1862–1868

    Article  PubMed  Google Scholar 

  10. Claxton AJ, Cramer J, Pierce C (2001) A systematic review of the associations between dose regimens and medication compliance. Clin Ther 23: 1296–1310

    Article  PubMed  CAS  Google Scholar 

  11. Coleman VR (1985) Physician behaviour and compliance. J Hypertens Suppl 3: S69–S71

    PubMed  CAS  Google Scholar 

  12. Cox D, Stone J (2006) Managing self-injection difficulties in patients with relapsing-remitting multiple sclerosis. J Neurosci Nurs 38: 167–171

    PubMed  Google Scholar 

  13. D’alisa S, Miscio G, Baudo S et al. (2006) Depression is the main determinant of quality of life in multiple sclerosis: a classification-regression (CART) study. Disabil Rehabil 28: 307–314

    Article  Google Scholar 

  14. Dimatteo MR (1995) Patient adherence to pharmacotherapy: the importance of effective communication. Formulary 30: 596–598, 601–602, 605

    PubMed  CAS  Google Scholar 

  15. Dimatteo MR (2004) Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol 23: 207–218

    Article  PubMed  Google Scholar 

  16. Dimatteo MR (2004) Variations in patients‘ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care 42: 200–209

    Article  PubMed  Google Scholar 

  17. Dimatteo MR, Lepper HS, Croghan TW (2000) Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 160: 2101–2107

    Article  PubMed  CAS  Google Scholar 

  18. Durelli L, Verdun E, Barbero P et al. (2002) Every-other-day interferon beta-1b versus once-weekly interferon beta-1a for multiple sclerosis: results of a 2-year prospective randomised multicentre study (INCOMIN). Lancet 359: 1453–1460

    Article  PubMed  CAS  Google Scholar 

  19. Facione NC (1999) Breast cancer screening in relation to access to health services. Oncol Nurs Forum 26: 689–696

    PubMed  CAS  Google Scholar 

  20. Farmer D, Reddick B, D’agostino R et al. (2007) Psychosocial correlates of mammography screening in older African American women. Oncol Nurs Forum 34: 117–123

    Article  PubMed  Google Scholar 

  21. Feinstein A (2005) The clinical neuropsychiatry of multiple sclerosis. CNS Spectr 10: 362

    PubMed  Google Scholar 

  22. Fraser C, Hadjimichael O, Vollmer T (2001) Predictors of adherence to Copaxone therapy in individuals with relapsing-remitting multiple sclerosis. J Neurosci Nurs 33: 231–239

    PubMed  CAS  Google Scholar 

  23. Fraser C, Morgante L, Hadjimichael O et al. (2004) A prospective study of adherence to glatiramer acetate in individuals with multiple sclerosis. J Neurosci Nurs 36: 120–129

    Article  PubMed  Google Scholar 

  24. Gray SL, Mahoney JE, Blough DK (2001) Medication adherence in elderly patients receiving home health services following hospital discharge. Ann Pharmacother 35: 539–545

    Article  PubMed  CAS  Google Scholar 

  25. Haynes RB, Yao X, Degani A et al. (2005) Interventions to enhance medication adherence. Cochrane Database Syst Rev 4: CD000011

    PubMed  Google Scholar 

  26. Hunot VM, Horne R, Leese MN et al. (2007) A cohort study of adherence to antidepressants in primary care: the influence of antidepressant concerns and treatment preferences. Prim Care Companion J Clin Psychiatry 9: 91–99

    PubMed  Google Scholar 

  27. Julian L, Merluzzi NM, Mohr DC (2007) The relationship among depression, subjective cognitive impairment, and neuropsychological performance in multiple sclerosis. Mult Scler 13: 81–86

    Article  PubMed  CAS  Google Scholar 

  28. Katapodi MC, Facione NC, Miaskowski C et al. (2002) The influence of social support on breast cancer screening in a multicultural community sample. Oncol Nurs Forum 29: 845–852

    Article  PubMed  Google Scholar 

  29. Kobelt G, Berg J, Lindgren P et al. (2006) Costs and quality of life of multiple sclerosis in Germany. Eur J Health Econ [Suppl 2] 7: S34–S44

  30. Kudielka BM, Broderick JE, Kirschbaum C (2003) Compliance with saliva sampling protocols: electronic monitoring reveals invalid cortisol daytime profiles in noncompliant subjects. Psychosom Med 65: 313–319

    Article  PubMed  Google Scholar 

  31. Lee JY, Kusek JW, Greene PG et al. (1996) Assessing medication adherence by pill count and electronic monitoring in the African American Study of Kidney Disease and Hypertension (AASK) Pilot Study. Am J Hypertens 9: 719–725

    Article  PubMed  CAS  Google Scholar 

  32. Liebl A, Neiss A, Spannheimer A et al. (2001) [Costs of type 2 diabetes in Germany. Results of the CODE-2 study]. Dtsch Med Wochenschr 126: 585–589

    Article  PubMed  CAS  Google Scholar 

  33. Macintyre CR, Goebel K, Brown GV (2005) Patient knows best: blinded assessment of nonadherence with antituberculous therapy by physicians, nurses, and patients compared with urine drug levels. Prev Med 40: 41–45

    Article  PubMed  CAS  Google Scholar 

  34. Maclaughlin EJ, Raehl CL, Treadway AK et al. (2005) Assessing medication adherence in the elderly: which tools to use in clinical practice? Drugs Aging 22: 231–255

    Article  PubMed  Google Scholar 

  35. Malhotra S, Karan RS, Pandhi P et al. (2001) Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance. Postgrad Med J 77: 703–707

    Article  PubMed  CAS  Google Scholar 

  36. Meichenbaum D, Turk DC (1994) Therapiemotivation des Patienten. Huber, Bern

  37. Mohr DC, Boudewyn AC, Likosky W et al. (2001) Injectable medication for the treatment of multiple sclerosis: the influence of self-efficacy expectations and injection anxiety on adherence and ability to self-inject. Ann Behav Med 23: 125–132

    Article  PubMed  CAS  Google Scholar 

  38. Mohr DC, Cox D, Epstein L et al. (2002) Teaching patients to self-inject: pilot study of a treatment for injection anxiety and phobia in multiple sclerosis patients prescribed injectable medications. J Behav Ther Exp Psychiatry 33: 39–47

    Article  PubMed  Google Scholar 

  39. Mohr DC, Cox D, Merluzzi N (2005) Self-injection anxiety training: a treatment for patients unable to self-inject injectable medications. Mult Scler 11: 182–185

    Article  PubMed  Google Scholar 

  40. Mohr DC, Goodkin DE, Likosky W et al. (1997) Treatment of depression improves adherence to interferon beta-1b therapy for multiple sclerosis. Arch Neurol 54: 531–533

    PubMed  CAS  Google Scholar 

  41. Mohr DC, Goodkin DE, Likosky W et al. (1996) Therapeutic expectations of patients with multiple sclerosis upon initiating interferon beta-1b: relationship to adherence to treatment. Mult Scler 2: 222–226

    PubMed  CAS  Google Scholar 

  42. Mohr DC, Goodkin DE, Masuoka L et al. (1999) Treatment adherence and patient retention in the first year of a Phase-III clinical trial for the treatment of multiple sclerosis. Mult Scler 5: 192–197

    PubMed  CAS  Google Scholar 

  43. Mohr DC, Hart SL, Fonareva I et al. (2006) Treatment of depression for patients with multiple sclerosis in neurology clinics. Mult Scler 12: 204–208

    Article  PubMed  CAS  Google Scholar 

  44. Mohr DC, Likosky W, Boudewyn AC et al. (1998) Side effect profile and adherence to in the treatment of multiple sclerosis with interferon beta-1a. Mult Scler 4: 487–489

    PubMed  CAS  Google Scholar 

  45. Morris AB, Li J, Kroenke K et al. (2006) Factors associated with drug adherence and blood pressure control in patients with hypertension. Pharmacotherapy 26: 483–492

    Article  PubMed  Google Scholar 

  46. Morris LA, Halperin JA (1979) Effects of written drug information on patient knowledge and compliance: a literature review. Am J Public Health 69: 47–52

    PubMed  CAS  Google Scholar 

  47. Morrow D, Leirer V, Sheikh J (1988) Adherence and medication instructions. Review and recommendations. J Am Geriatr Soc 36: 1147–1160

    PubMed  CAS  Google Scholar 

  48. Ownby RL (2006) Medication adherence and cognition. Medical, personal and economic factors influence level of adherence in older adults. Geriatrics 61: 30–35

    PubMed  Google Scholar 

  49. Ownby RL, Hertzog C, Crocco E et al. (2006) Factors related to medication adherence in memory disorder clinic patients. Aging Ment Health 10: 378–385

    Article  PubMed  CAS  Google Scholar 

  50. Prosser LA, Kuntz KM, Bar-Or A et al. (2004) Cost-effectiveness of interferon beta-1a, interferon beta-1b, and glatiramer acetate in newly diagnosed non-primary progressive multiple sclerosis. Value Health 7: 554–568

    Article  PubMed  Google Scholar 

  51. Pullar T, Birtwell AJ, Wiles PG et al. (1988) Use of a pharmacologic indicator to compare compliance with tablets prescribed to be taken once, twice, or three times daily. Clin Pharmacol Ther 44: 540–545

    Article  PubMed  CAS  Google Scholar 

  52. Pullar T, Kumar S, Tindall H et al. (1989) Time to stop counting the tablets? Clin Pharmacol Ther 46: 163–168

    Article  PubMed  CAS  Google Scholar 

  53. Pullar T, Peaker S, Martin MF et al. (1988) The use of a pharmacological indicator to investigate compliance in patients with a poor response to antirheumatic therapy. Br J Rheumatol 27: 381–384

    Article  PubMed  CAS  Google Scholar 

  54. Raehl CL, Bond CA, Woods T et al. (2002) Individualized drug use assessment in the elderly. Pharmacotherapy 22: 1239–1248

    Article  PubMed  Google Scholar 

  55. Roter DL, Hall JA, Merisca R et al. (1998) Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care 36: 1138–1161

    Article  PubMed  CAS  Google Scholar 

  56. Rudd P, Byyny RL, Zachary V et al. (1988) Pill count measures of compliance in a drug trial: variability and suitability. Am J Hypertens 1: 309–312

    PubMed  CAS  Google Scholar 

  57. Ruggieri RM, Settipani N, Viviano L et al. (2003) Long-term interferon-beta treatment for multiple sclerosis. Neurol Sci 24: 361–364

    Article  PubMed  CAS  Google Scholar 

  58. Siegel D, Lopez J, Meier J (2007) Antihypertensive medication adherence in the Department of Veterans Affairs. Am J Med 120: 26–32

    Article  PubMed  Google Scholar 

  59. Van Dulmen S, Sluijs E, Van Dijk L et al. (2007) Patient adherence to medical treatment: a review of reviews. BMC Health Serv Res 7: 55

    Article  Google Scholar 

  60. Van Eijken M, Tsang S, Wensing M et al. (2003) Interventions to improve medication compliance in older patients living in the community: a systematic review of the literature. Drugs Aging 20: 229–240

    Article  Google Scholar 

  61. Vik SA, Hogan DB, Patten SB et al. (2006) Medication nonadherence and subsequent risk of hospitalisation and mortality among older adults. Drugs Aging 23: 345–356

    Article  PubMed  Google Scholar 

  62. Who (2003) Adherence to Long-term Therapies. WHO, Genf

  63. Yiannakopoulou E, Papadopulos JS, Cokkinos DV et al. (2005) Adherence to antihypertensive treatment: a critical factor for blood pressure control. Eur J Cardiovasc Prev Rehabil 12: 243–249

    Article  PubMed  Google Scholar 

  64. Tremlett HI, Oger J (2003) Interrupted therapy: stopping and switching of the beta-interferons prescribed for MS. Neurology 61: 551–554

    PubMed  Google Scholar 

  65. Milanese C, La Mantia L, Palombo R et al. (2003) A post-marketing study on interferon beta 1b and 1a treatment in relapsing-remitting multiple sclerosis: different response in drop-outs and treated patients. J Neurol Neurosurg Psychiatry 74: 1689–1692

    Article  PubMed  CAS  Google Scholar 

  66. Rio J, Porcel J, Tellez N et al. (2005) Factors related with treatment adherence to interferon beta and glatiramer acetate therapy in multiple sclerosis. Mult Scler 11: 306–309

    Article  PubMed  CAS  Google Scholar 

  67. Haas J, Firzlaff M (2005) Twenty-four-month comparison of immunomodulatory treatments – a retrospective open label study in 308 RRMS patients treated with beta interferons or glatiramer acetate (Copaxone). Eur J Neurol 12: 425–431

    Article  PubMed  CAS  Google Scholar 

  68. O’Rourke KE, Hutchinson M (2005) Stopping beta-interferon therapy in multiple sclerosis: an analysis of stopping patterns. Mult Scler 11: 46–50

    Article  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Die Autoren Kern, Reichmann und Ziemssen erhielten in der Vergangenheit Vortrags- bzw. Beratungshonorare der Hersteller der im Artikel erwähnten Präparate (Biogen Idec, Bayer Schering, Merck-Serono, TEVA/Sanofi Aventis). Das MS-Zentrum Dresden erhält finanzielle Zuwendung für Forschungstätigkeiten und Weiterbildungsveranstaltungen der oben genannten Firmen. Die vorliegende Arbeit wurde unterstützt durch die Roland-Ernst-Stiftung.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Neurologie,Multiple Sklerose Zentrum, Carl Gustav Carus Universitätsklinik, Fetscherstraße 74, 01307, Dresden, Deutschland

    S. Kern, H. Reichmann & T. Ziemssen

Authors
  1. S. Kern
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Reichmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Ziemssen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Kern.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kern, S., Reichmann, H. & Ziemssen, T. Therapieadhärenz in der neurologischen Praxis. Nervenarzt 79, 877–890 (2008). https://doi.org/10.1007/s00115-008-2419-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00115-008-2419-0

Schlüsselwörter

Keywords

Search

Navigation