Patient versus general practitioner perception of problems with treatment adherence in type 2 diabetes: from adherence to concordance.
OBJECTIVE
To determine the prevalence of problems with treatment adherence among type-2 diabetic patients with regards to medication, dietary advice, and physical activity; to identify the associated clinical and psychosocial factors; and to investigate the degree of agreement between patient-perceived and GP-perceived adherence.


METHODS
Consecutive patients were solicited during visits to 39 GPs. In total, 521 patients self-reported on treatment adherence, anxiety and depression, and disease perception. The GPs reported clinical and laboratory data and patients' adherence. A multivariate analysis identified the factors associated with adherence problems.


RESULTS
Problems of adherence to medication, dietary advice, and physical activity recommendations were reported by 17%, 62%, and 47% of the patients, respectively. Six independent factors were found associated with adherence problems: young age, body-mass index (BMI) > 30 kg/m(2), glycosylated haemoglobin (HbA(1c)) > 8%, single life, depression, and perception of medication as a constraint. Agreement between patients' and GPs' assessments of treatment problems reached 70%.


CONCLUSIONS
In type 2 diabetes, problems with dietary advice or physical activity are far more frequent than problems with medication, and not all physicians are fully aware of patients' problems. More active listening and shared decision-making should enhance adherence and improve outcomes.
Moreau
Alain
A
Université Lyon I, Département de Médecine Générale, Lyon, France. alainmoreau0917@orange.fr
Aroles
Vincent
V
Souweine
Gilbert
G
Flori
Marie
M
Erpeldinger
Sylvie
S
Figon
Sophie
S
Imbert
Patrick
P
Denis
Angelique
A
Iwaz
Jean
J
Riou
Jean-Paul
JP
Ploin
Dominique
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011795:Surveys and Questionnaires