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Medication adherence in the older adults with chronic multimorbidity: a systematic review of qualitative studies on patient’s experience

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Key summary points

AbstractSection Aim

To investigate potential factors associated with medication adherence in the older and chronic population through a PRISMA systematic review of qualitative studies on patients’ experience.

AbstractSection Findings

The main barriers and facilitators of non-adherence were found to be patients’ beliefs about polypharmacy and drug prioritization, patient’s experience and capabilities, prescriber-patient relationship, health literacy, treatment characteristics and complexity, family and social support.

AbstractSection Message

The present findings, derived from two well-established theoretical frameworks (ABC Taxonomy, Three Factor model) and stemming from the patient’s narratives, may provide healthcare professionals with practical information to enhance medication adherence in clinical practice.

Abstract

Purpose

Medication non-adherence represents a socially relevant challenge, particularly when interlinked to multiple chronic diseases and polypharmacy. Non-adherence rates affect treatment efficacy and increase health care costs. The aim of the study was to identify factors influencing medication adherence in the older adults through a systematic review of qualitative studies on patients’ experience.

Methods

Two electronic databases were searched for qualitative studies on medication adherence in chronic diseases (hypertension, heart disease, COPD, asthma) involving people aged 65 + . The systematic review was performed according to the PRISMA statement guidelines, employing theoretical frameworks of the ABC Taxonomy of patient adherence and Three Factor model of determinants of behaviour.

Results

The initial database search identified 1234 records, of which 39 studies were considered eligible. Most of the studies focused on hypertension and were conducted in English-speaking countries. According to the ABC Taxonomy, Persistence and Implementation were the most often considered phases. Considering the Three Factor model, the most often reported themes were Information and Strategies upon being adherent. Stemming from the review findings and the patients’ narratives, a new integrated model was proposed. It reports the patient’s decisional flowchart describing barriers and facilitators (personal, social and environmental) to adherence.

Conclusion

Medication adherence is a complex and multifaceted process. The implementation of theoretical frameworks along with a patient-centred perspective may provide clinicians with useful suggestions for clinical practice, enhancing the patient’s ability to adhere.

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Funding

The present review was co-funded by the Erasmus + Programme of the European Union – Skills4Adherence- 2017–1-PL01-KA202-038672. Also, this work received financial support from FCT/MCTES (UIDB/04378/2020).

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Authors and Affiliations

  1. Psychology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Istituto di Montescano (PV), Pavia, Italy

    M. Maffoni, S. Traversoni & A. Giardini

  2. Porto4Ageing-Competences Centre on Active and Healthy Ageing, University of Porto, Porto, Portugal

    E. Costa & L. Midão

  3. UCIBIO REQUIMTE, Faculty of Pharmacy, University of Porto, Porto, Portugal

    E. Costa & L. Midão

  4. Department of Family Medicine, Medical University of Lodz, Lodz, Poland

    P. Kardas & M. Kurczewska-Michalak

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  1. M. Maffoni
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Contributions

MM, ST and AG performed the revision of the literature, providing substantial input and drafting and reviewing the manuscript. An overall supervision to the reviewing procedure (both of the literature and of the manuscript) was finalized by PK, MK-M, LM and EC. All authors gave their final approval.

Corresponding author

Correspondence to A. Giardini.

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Conflict of interest

PK received speaker’s honoraria from Aflofarm, Fresenius, Polpharma and Sandoz; and got funding from a grant from European Union’s Health Programme (2014–2020) for SIMPATHY project (663082), outside this work, and The European Commission ERASMUS + Project Skills4Adherence (Grant Agreement Number: 2017-1-PL01-KA202-038672). The other authors declare no conflict of interest.

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Maffoni, M., Traversoni, S., Costa, E. et al. Medication adherence in the older adults with chronic multimorbidity: a systematic review of qualitative studies on patient’s experience. Eur Geriatr Med 11, 369–381 (2020). https://doi.org/10.1007/s41999-020-00313-2

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