Adherence to disease management interventions for chronic obstructive pulmonary disease patients: Patients' perspectives

Abstract

BACKGROUND: The management of chronic obstructive pulmonary disease (COPD) requires a disease management approach - a combination of pharmacotherapy, pulmonary rehabilitation and behavioural changes. Patient adherence to therapy has been found to be poor, with a negative influence on outcomes.AIM: To explore facots associated with adherence t disease management interventions from COPD patients' perspectives.METHOD: A subset of 28 patients with moderate to severe COPD participating in a community-based randomised controlled trial were interviewed in-depth about their health beliefs, and attitudes to and experiences with their disease, its management and their relationships with health professionals. The interviews were transcribed verbatim and analysed thematically.RESULTS: Patients with a range of sociodemographic backgrounds and varying disease severity were interviewed. Adherence to disease management programs in COPD was found to be a complex process driven by health beliefs and experiences related to patient, treatment, disease and health professionals. 18 major themes related to adherent behaviour were identified, The balance between reservations in following treatment recomendations and motivating factors for following those recommendations was likely to determine decisions to adhere to disease management programs.CONCLUSION: The study highlighted the importance of consulation with the patient in the management of COPD. Treatment recommendations that fitted into patients' existing routines were more likely to be successful. Health professionals could enhance adherence by being empathic, improve patients' knowledge about the disease and faith in the treatment, and reduce their concerns about the treatment.