Multidimensional analysis of treatment adherence in patients with multiple chronic conditions. A cross-sectional study in a tertiary hospital

ObjectiveDetermine treatment adherence in patients with multiple chronic conditions (MCC).MethodsA random patient sample ≥15 years, discharged from hospital with ≥1 chronic conditions (CC) was interviewed after 6–12 months. Analysis included variables in 5 dimensions (WHO): socio-demographics, disease, treatment, patient and health system characteristics. Morisky–Green adherence questionnaire was used. High chronic treatment complexity was defined as: >3 pills/day, >6 inhalations/day, >1 injection/day, pharmacological treatment plus diet or self-monitoring techniques.Results301 patients were interviewed (62 ± 15 years, 59% males). Despite good treatment information perception (79%), only 3% followed the patient education programme. Poor adherents (82%) were older (64 ± 14 years vs. 55 ± 16 years), had more CC (3.25 ± 2.02 vs. 2.62 ± 2.72), a higher frequency of hypertension (44% vs. 15%), ischaemic heart diseases: (21% vs. 4%), hyperlipidaemia (19% vs. 6%), more pills/day (5.78 ± 4.14 vs. 3.20 ± 4.70) and more complex treatments (95% vs. 70%) (p < 0.05). On multivariate analysis number of CC [3.68 (0.75–18.15)], pills/day [2.23 (1.02–4.84)], treatment complexity [4.00 (1.45–11.04)], and hypertension [2.57 (1.06–6.25)] were predictive of poor adherence (OR 95% CI p < 0.05).ConclusionThe WHO conceptual framework allows the construction of poor adherence risk profiles in patients with MCC after hospital discharge.Practice implicationsPredictive variables of poor adherence could help clinicians detect patients with MCC most likely to present poor adherence.