John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Promoting and assessing adherence Volume 16, special issue 2, septembre 2009

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Authors
Clinique universitaire d’hépatogastroentérologie, pôle Digidune, CHU A.-Michallon, Grenoble, BP 217, 38043 Grenoble cedex 09, France, Centre de recherche Inserm/UJF U823 IAPC, Institut Albert-Bonniot, Domaine de la Merci, 38706 La Tronche cedex, France

Compliance or “adherence” to treatment is a crucial issue during the management of chronic diseases. Favouring adherence should be one of the therapeutic goals in patients with chronic disease, such as chronic hepatitis B. This process implies to take into account the parameters conditioning compliance in order to individualise the management of patients, especially by the conception of therapeutic educational programs. Determinants of compliance can be classified according to five dimensions: 1) related to the patient; 2) to the disease; 3) to the type of treatment; 4) to the characteristics of the healthcare system, and 5) to socioeconomic factors. Theoretical models of health behaviour supported promoting compliance. Numerous studies measuring the impact of actions promoting adherence have been conducted since the 1970s. However, few have been able to demonstrate a beneficial effect both on compliance and on classical therapeutic end-points of studied chronic diseases. Finally, actions promoting compliance should be evaluated by checking compliance itself, either by direct or indirect methods.