title: Assessing patient adherence to chronic diseases treatment: differentiating between epidemiological and clinical approaches.
abstract: This review discusses the concepts and methods for assessing patient adherence to treatment, as applied to both epidemiological and clinical approaches within real health care practices. For the epidemiological approach, the assessment must be as accurate as possible. Self-reported questionnaires are the most feasible option in most circumstances, but most demonstrate low sensitivity combined with high specificity. We suggest that self-reported outcomes, where feasible, can increase the sensitivity for non-adherence of these questionnaires. In the clinical approach an accurate distinction between adherents and non-adherents is less useful. For the health provider, it is more important to be aware of the particular situation that each patient is currently experiencing with his/her treatment. Self-reported questionnaires applied in clinical settings can help the health provider to form an objective opinion. In any event, the patient-provider dialogue is still the best approach to assess patient adherence as well as to deliver good care.
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brasil. mibnemes@usp.br
authors.forename: Maria Ines Battistella
authors.initials: MI
authors.lastname: Nemes
authors.forename: Ernani Tiaraju de Santa
authors.initials: ET
authors.lastname: Helena
authors.forename: Joselita M M
authors.initials: JM
authors.lastname: Caraciolo
authors.forename: Cáritas Relva
authors.initials: CR
authors.lastname: Basso
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D006801:Humans; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires / Q000592:standards*; D016896:Treatment Outcome