Optimierung der Adhärenz bei Personen mit chronischen Erkrankungen Prädiktoren, Erfassung, Intervention

Non-adherence in persons with chronic diseases is a major challenge for the health care system. Between 30 and 50% of patients do not take their medication as prescribed (Cutler & Everett, 2010; Vermeire et al., 2001). The reasons for non-adherence are individual and multifaceted (Brawley & Culos-Reed, 2000; Osterberg & Blaschke, 2005; Rief & Nestoriuc, 2015; Vermeire et al., 2001). This publication-based dissertation examined, psychological aspects for non-adherence, its assessment, as well as predictors for short-term fluctuations of adherence and a potential intervention to enhance adherence in persons with diabetes mellitus type 2. Previous adherence programs have often yielded unsatisfactory results, because psychological risks for nonadherence have not been sufficiently considered. In the first study a narrative review was conducted to provide an overview of psychological adherence risk factors. Results showed that the quality of the doctor-patient-interaction has a significant influence on medication adherence. Other risk factors such as previous adherence behavior, a low acceptance of one's own disease, beliefs about the disease and medication as well as the fear of potential side effects were not sufficiently considered in previous adherence programs. In addition, interventions should be adapted to the cognitive impairments and comorbidities, such as depressive symptoms of the patients. In the second study, a screener was developed which, included these psychological risk factors. In an online study, the "Adherence Risk Profile Screener" (AdRisk) was validated. 677 German-speaking individuals suffering from chronic disease (diabetes mellitus type 2, high blood pressure, epilepsy, chronic obstructive pulmonary disease, rheumatoid arthritis or Crohn's disease) took part of the study. The AdRisk shows good psychometric characteristics. As an economic screening, the instrument can be used for various chronic physical diseases in clinical settings. The broad assessment of different barriers makes it possible to determine the individual needs of each patient. The aim of the third study was to identify psychological predictors that can explain the incremental variance in a short-term (four-week) fluctuation of current versus previous adherence. Path analyses revealed a positive association of age, quality of doctor-patient interaction, stress and self-efficacy in terms of drug intake and adherence. We found a negative correlation for the satisfaction with knowledge about medication and the degree of anxiety. Several psychological risk factors predicted intra-individual variations for non-adherence after 4 weeks beyond the explained variance from previous drug adherence. The fourth study is a protocol of evaluating a psychological online intervention for patients with diabetes. The study will investigate the improvement in adherence behavior of persons with diabetic type 2 if the diabetes-specific online program is offered in addition to Care as usual (CAU). In particular, it should be clarified whether the expectations of the treatment and the disease have a mediating effect. The findings of the dissertation show that the consideration of psychological aspects is of high relevance for the improvement of adherence in patients with chronic diseases. The identification and systematic assessment of psychological risk factors and predictors of intra-individual fluctuations are essential. In addition, online interventions with a focus on expectations could have the potential to improve adherence behavior.