title: A Systematic Review of Factors Associated with Non-Adherence to Treatment for Immune-Mediated Inflammatory Diseases.
abstract: BACKGROUND
  Non-adherence impacts negatively on patient health outcomes and has associated economic costs. Understanding drivers of treatment adherence in immune-mediated inflammatory diseases is key for the development of effective strategies to tackle non-adherence.
  
  
  OBJECTIVE
  To identify factors associated with treatment non-adherence across diseases in three clinical areas: rheumatology, gastroenterology, and dermatology.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Articles published in PubMed, Science Direct, PsychINFO and the Cochrane Library from January 1, 1980 to February 14, 2014.
  
  
  METHODS
  Studies were eligible if they included patients with a diagnosis of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease, or psoriasis and included statistics to examine associations of factors with non-adherence.
  
  
  METHODS
  Data were extracted by the first reviewer using a standardized 23-item form and verified by a second/third reviewer. Quality assessment was carried out for each study using a 16-item quality checklist.
  
  
  RESULTS
  73 studies were identified for inclusion in the review. Demographic or clinical factors were not consistently associated with non-adherence. Limited evidence was found for an association between non-adherence and treatment factors such as dosing frequency. Consistent associations with adherence were found for psychosocial factors, with the strongest evidence for the impact of the healthcare professional-patient relationship, perceptions of treatment concerns and depression, lower treatment self-efficacy and necessity beliefs, and practical barriers to treatment.
  
  
  CONCLUSIONS
  While examined in only a minority of studies, the strongest evidence found for non-adherence were psychosocial factors. Interventions designed to address these factors may be most effective in tackling treatment non-adherence.
authors.affiliation: Department of Psychology, London South Bank University, London, UK.
authors.forename: Eleni
authors.initials: E
authors.lastname: Vangeli
authors.affiliation: Psychological Medicine, King's College London, London, UK.
authors.forename: Savita
authors.initials: S
authors.lastname: Bakhshi
authors.affiliation: Atlantis Healthcare, London, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Baker
authors.affiliation: University College London, London, UK.
authors.forename: Abigail
authors.initials: A
authors.lastname: Fisher
authors.affiliation: London Metropolitan University, London, UK.
authors.forename: Delaney
authors.initials: D
authors.lastname: Bucknor
authors.affiliation: Psoriasis-Center at the Department of Dermatology, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mrowietz
authors.affiliation: School of Clinical Medicine, University of Cambridge, Cambridge, UK.
authors.forename: Andrew J K
authors.initials: AJ
authors.lastname: Östör
authors.affiliation: Inserm U954 and Department of Gastroenterology, Université de Lorraine, Vandoeuvre-les-Nancy, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.affiliation: AbbVie Inc, North Chicago, IL, USA.
authors.forename: Ana P
authors.initials: AP
authors.lastname: Lacerda
authors.affiliation: Institute of Pharmaceutical Science, King's College London, 5th Floor, Franklin-Wilkins Building, 150 Stamford Street, London, SE1 9NH, UK. John.weinman@kcl.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Weinman
mesh_terms: D001168:Arthritis / Q000188:drug therapy*; D015535:Arthritis, Psoriatic / Q000188:drug therapy; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D055118:Medication Adherence; D011565:Psoriasis / Q000188:drug therapy; D013167:Spondylitis, Ankylosing / Q000188:drug therapy; D016896:Treatment Outcome
keywords: Inflammatory bowel disease; Patient adherence; Psoriasis; Psoriatic arthritis; Rheumatology