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Indian J Med Res. Download references. We acknowledge the Management team of the participating hospitals for their support during the data collection phase of the study.
You can also search for this author in PubMed Google Scholar. CDU: Conceptualized the study, designed it, acquired the data, conducted statistical analysis and interpretation, drafted the initial manuscript and made reviews on the final manuscript. CAO: Supervised the study, interpretation of result, made substantial review to the final manuscript.
PAA: made substantial review to the final manuscript. ENO: made substantial review to the final manuscript. MSB: made substantial review to the final manuscript.
LO: made substantial review to the final manuscript. All authors read and approved the final version of the manuscript. Correspondence to Chukwuma David Umeokonkwo. We also obtained written informed consent from the participants. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background Retaining patients on antiretroviral treatment in care is critical to sustaining the vision. Method We conducted a cross-sectional study among patients who had taken antiretroviral treatment for at least one complete year.
Result We found a comparable level of retention in care private Conclusion Retention in care was high and comparable among the different hospital types and HIV disclosure status was an important factor relating to retention in care. Background Provision of antiretroviral treatment to HIV patients has led to longer survival, better quality of life and reduction of HIV transmission.
Methods We conducted a comparative cross-sectional study among adult patients receiving antiretroviral treatment in secondary level hospitals in Anambra State. Study instrument We administered a structured pretested questionnaire on consenting participants.
Measurement of variables We assessed retention in care using the 3-month visit constancy method [ 9 , 13 , 14 ]. Depressed patients experience pessimism, cognitive impairments, and withdrawal from social support, all of which can diminish both the willingness and ability to follow treatment regimens.
Depression is a prevalent and powerful factor in health and illness, and one that cannot be ignored. It is associated with impairment equal to or greater than that of chronic recurrent disorders such as diabetes, hypertension, arthritis, and emphysema Wells et al , Depression is currently the most prevalent mental illness and a cause of immense disability in industrialized countries.
Depression has been cited as the most common clinical problem that primary care physicians are called upon to diagnose and treat. These conditions, however, often go untreated Young et al Thus, the opportunity to manage major risk factors for nonadherence and for serious patient morbidity and mortality is often missed in primary care.
Why does such a serious risk factor for nonadherence and other poor healthcare outcomes so often go unrecognized in the primary care medical interaction? Research suggests that both patients and their physicians contribute jointly to this problem in the medical interaction.
Patient factors that prevent recognition of depression in primary care include lack of awareness and understanding of depression symptoms, complaints of physical symptoms that take precedence or confuse the clinical picture, and failure to admit to psychological symptoms because they fear a stigma of mental illness Docherty Patients may be reluctant to talk about non-medical matters because they expect physician disinterest or the risk of embarrassment, or because of anxiety about the possible significance of their psychological symptoms Roter and Hall Physician factors can also interfere with the recognition of depression in primary care settings.
These include lack of knowledge about the disease, lack of training in the management of depression, reluctance to inquire about their patients' emotional states, and limited time available for patients Docherty ; Carney et al Indeed, patients' health status can influence the degree of interest and responsiveness they receive. Physicians have been found to convey greater negativity toward physically or mentally less healthy patients and to act more positively toward healthier ones Hall et al Despite many barriers to recognition and treatment, depression continues to play a central role in nonadherence.
Appreciation of the importance of patients' mental health in the care of their acute and chronic medical conditions can help to reduce the risks of nonadherence and contribute to more positive health outcomes Ballenger et al New and developing models of depression management in primary care show great promise for improving patient commitment to and ultimately the success of medical treatments. The first step toward improving patient adherence involves accurately assessing whether or not patients have followed the treatments recommended to them.
The precise estimation of patient adherence is not easy, and a full understanding of whether and why any given patient chooses and is able to adhere is often elusive. Patients tend to be truthful in their adherence reports only when they feel free to admit adherence difficulties without the risk of criticism and in the context of true partnership with their physicians Haug and Lavin ; Hays and DiMatteo The accurate assessment of adherence depends, to a large degree, on the development of a trusting and accepting relationship between the patient and the healthcare team.
Adherence assessments that are simple presenting as little burden to the respondent as possible and nonthreatening will also likely yield the most honest and accurate responses. Realistic assessment of patients' knowledge and understanding of the regimen, and their belief in it, will enable a more effective targeting of the potential for adherence problems. Many of the factors necessary to carry out such assessment are the very elements that foster communication and partnership in the medical visit.
Patients need to be given the opportunity to tell their story Mishler ; Smith and Hoppe ; Roter and Hall ; Roter ; Haidet and Paterniti and to present their point of view to the physician. From this, much information about patients' beliefs, attitudes, subjective norms, cultural contexts, social supports, and emotional health challenges particularly depression can be learned. These elements are central to the establishment of adherence intentions, and must be explored and discussed in the therapeutic relationship.
Perfect agreement will not always be reached, and in fact may not be desirable. Some degree of conflict between the views of physician and patient may be necessary if truly adult collaboration is to take place and a variety of therapeutic options, and ways to adhere to them, jointly considered Katz ; Wolf The acknowledgment of differences is an important part of building respectful and trusting relationships between physicians and their patients.
No single intervention strategy can improve the adherence of all patients Hamilton et al ; Cheng et al ; Roter et al Success depends upon tailoring interventions to the unique characteristics of patients, disease conditions, and treatment regimens McDonald et al For example, some patients may be unable to maintain a complicated regimen without a strong system of social support and many prompts to remind them of what needs to be done.
Other patients may have problems keeping appointments because they do not have access to reliable transportation or because family emergencies arise. Still others may find that side effects of medications are prohibitive or they may simply be unmotivated.
The healthcare provider must be attuned to the individual, picking up on subtle hints verbal and nonverbal that the patient may express. A flexible mindset in which the physician thinks creatively about treatment options is always an asset. The physician—patient partnership itself, however, remains at the core of all successful attempts to improve adherence behaviors. Participation, engagement, collaboration, negotiation, and sometimes compromise enhance opportunities for optimal therapy in which patients take responsibility for their part of the adherence equation.
These partnerships foster greater patient satisfaction, improved patient adherence, and ultimately optimal healthcare outcomes.
National Center for Biotechnology Information , U. Ther Clin Risk Manag. Author information Copyright and License information Disclaimer. All rights reserved. This article has been cited by other articles in PMC. Abstract Quality healthcare outcomes depend upon patients' adherence to recommended treatment regimens. Keywords: patient adherence, health outcomes, physician—patient relationship.
Introduction For most medical conditions, correct diagnosis and effective medical treatment are essential to a patient's survival and quality of life.
Research on patient adherence The research literature on patient adherence is extensive. Factors that affect adherence Cognitive factors It goes without saying, perhaps, that patients must understand what they are supposed to do before they can follow medical recommendations. Interpersonal factors The interpersonal dynamics of the physician—patient relationship play an important role in determining a variety of patient outcomes including patient adherence to their treatment recommendations.
Patient involvement and participatory decision making Studies have found that both patient satisfaction and patient adherence are enhanced by patients' involvement and participation in their care Martin et al , Patients' attitudes Patients' understanding of their recommendations and good physician—patient relationships are, of course, not sufficient to eliminate the risk of nonadherence.
Depression In meta-analytic work, findings suggest that one of the strongest predictors of patient nonadherence to medical treatment is patient depression DiMatteo et al Improving patient adherence The first step toward improving patient adherence involves accurately assessing whether or not patients have followed the treatments recommended to them. References Ajzen I. From intentions to actions: a theory of planned behavior.
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Support Center Support Center. External link. Please review our privacy policy. Association between adherence and viral outcomes. Cohen et al, 33 USA. Patients who received ART as a single pill per day were significantly more likely to be highly adherent to therapy than those who received MTR. Cooke et al, 34 USA. Patients who received STRs were about 1. Hanna et al, 5 USA. STR use was associated with increased adherence and virologic suppression.
Kauf et al, 35 USA. Langness et al, 36 USA. Rogato et al, 37 Europe. STRs were associated with improved adherence when compared with a matched cohort of patient regimens consisting of recommended once-daily MTRs.
Raffi et al, 38 France. Sax et al, 39 USA. Sutton et al, 40 USA. The STR was associated with higher adherence rates and a lower risk of hospitalization both in the adjusted and unadjusted analyses. Taneja et al, 41 USA. Tennant et al, 32 USA. Treatment regimen was not predictive of adherence. Baxi et al, 47 USA. Higher self-reported adherence was associated with higher odds of suppression. Bonora et al, 50 Italy. Treatment-experienced HIV-infected patients Observational study.
Suboptimal adherence was associated with virological failure. Cohen et al, 42 Multinational. Dragovic et al, 51 Serbia. Multivariate analyses revealed that the single factor independently related to a favorable response to HAART was good compliance. Single-tablet regimen use was associated with increased adherence and virologic suppression. Hernandez Arroyo et al, 52 Spain. Improved adherence increased permanence time of the patient with undetectable plasma viral loads and improved patient lymphocyte counts.
Jayaweera et al, 53 USA. Adult patients weighing 40 kg or more with no more than 7 days of prior antiretroviral therapy Observational study. Josephson et al, 43 Sweden. The number of missed doses self-reported adherence reported was not predictive of virologic failure, treatment failure, or plasma concentration of lopinavir, nor was it predictive of the viral load decline from baseline to week 4, in any of the treatment groups. Julian et al, 54 USA. Lathouwers et al, 44 Multinational. A higher frequency of suboptimal adherence was reported in patients with virologic failure compared with patients without virologic failure.
Martin et al, 55 Spain. Patients taking first-line therapy and antiretroviral- experienced patients Observational study.
Nelson et al, 45 Multinational. Podzamczer et al, 56 Sax et al, 46 North America. Patients adherent to ART were 3-fold more likely than non-adherent patients to be virologically suppressed. Torres-Cornejo et al, 57 Spain. Viswanathan et al, 48 USA.
Wilkins et al, 49 Multinational.
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