A Spoonful of Sugar doesn’t always help the medicine go down.
At a diabetes workshop we ran a few years ago, a consultant remarked that despite a mass of new treatments that had been introduced during his career, we had made very little headway on the major outcomes that matter to patients.
In an unusual – perhaps even unprecedented – move, your correspondent has been tidying his office and has come across a paper that may give us a hint. For those who want the reference, it’s Variations in Patients’ Adherence to Medical Recommendations – A Quantitative Review of 50 Years of Research by M. R. DiMatteo, and you can find it on the internet at http://www.robindimatteo.com/uploads/3/8/3/4/38344023/variations.pdf.
DiMatteo conducted a meta-analysis of a large number of studies that reported adherence measures, and had hypothesised that there could be three main reasons for poorer adherence:
1) when regimens are pervasive (e.g. behavioral) rather than circumscribed (e.g. medication),
2) when illness is less serious and the consequences of nonadherence might seem lower, and
3) when resources such as income and education are wanting.
These all seem fairly convincing postulates. Yet table 2 of his paper is a little surprising. As one might expect, adherence was high for HIV, arthritis, gastrointestinal disorders and cancer but it was lowest for pulmonary diseases, diabetes and sleep disorders. It is surprising in the light of hypothesis 2 that diabetes should be so far down the table.
So what’s wrong? Are we failing to convince patients of the consequences of non-adherence or the benefits of treatment? Are we lacking in patient education? Do the treatments carry such a burden of side-effects that patients deliberately do not take them? Or are treatment regimens simply so complex that patients don’t know what we want them to do and therefore don’t adhere?
The JoMO/UKCPA Medicines Optimisation in Diabetes Workshop (Manchester, 17th May) will include over 20 satellites and contributions from many experts in this field. We’ll be surprised if some of these questions aren’t answered there.
You can book online at www.pmhealthcare.co.uk/events.