Epidemiology

Treatment adherence rates vary widely depending on the nature of the specific physical condition, the type of treatment prescribed, and the criteria used to define adherence (La Greca 1990). No accepted gold standard exists to assess adherence. Many studies rely on self-report, a technique that has been identified as unreliable in adherence research (Bender et al. 2003; Chesney 2006). The use of diverse methods of assessment across studies makes it problematic to compare results from the different studies or to reliably arrive at single estimates of adherence prevalence. Given these limitations, reviews suggest that 33% of patients with acute physical conditions and that 50%-55% of those with chronic physical illnesses fail to adhere to their treatment regimens (Shaw et al. 2003). Similarly, the World Health Organization (2003) reported a nonadher-ence rate of about 50% in industrialized nations.

Studies of physical and quality-of-life outcomes have shown a direct relationship between nonadher-ence and rates of morbidity and mortality in, for example, patients with asthma (Bender et al. 1997), HIV (Munakata et al. 2006), diabetes mellitus (Ellis et al. 2008), and cardiovascular illness (Bramlage et al. 2007), as well as transplant recipients (Dob-bels et al. 2005; Fredericks et al. 2008; Molmenti et al. 1999; Morrissey et al. 2007; Shemesh 2004a, 2004b, 2007; Shemesh et al. 2000, 2004, 2007; Venkat et al. 2008; Vlaminck et al. 2004). Treatment nonadherence is considered the single most important determinant of organ rejection and poor medical outcomes (Shemesh et al. 2007; Venkat et al. 2008). The increased morbidity associated with nonadherence has been related to higher health care costs, with an estimated cost to the U.S. health care system of as much as $100 billion per year (Berg et al. 1993; Lee et al. 2006; Muszbek et al. 2008).

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