The problem of adherence to the treatment in modern medicine: Possibilities of solution, impact on the effectiveness of therapy and disease outcomes

Abstract

The problem of adherence remains one of the currently important and at the same time the most difficult one to solve for modern medicine and society. Despite five decades of scientific research on this issue, numerous attempts to create reliable diagnostic tests, the search for methods to increase patient adherence to the medical recommendations, nevertheless, most of the questions on this topic remain unanswered. Adherence is a proven factor that greatly influences the effectiveness of treatment and the outcomes of the disease. The article discusses some reasons explaining the absence of significant breakthroughs in solving the problem of adherence: (1) unresolved issues with terminology, especially the lack of Russian-language terms, the absence of both a uniform definition of "adherence", which takes into account the variety of aspects included in it and a generally accepted classification of terms by the topic; (2) a lack of reliable diagnostic tests that are convenient for clinical practice, and the absence of a "gold standard" method for diagnosing adherence; (3) a lack of valid diagnostic tests to determine the adherence of physicians to the clinical recommendations and official medicine usage instructions as well as tests to assess the quality of therapy; (4) a large and growing number of identified factors that influence adherence, and usually not taken into account the mutual influence of these factors; (5) frequent inattention to fact that in the same patients there may be different adherence to different medicines, etc. Besides, the possible prospects for future researches are identified, in particular the need to assess adherence inseparably to the quality control of treatment, as well as the importance of a comprehensive impact on all or at least most of the factors and aspects of adherence identified to date.