Improving patient adherence is a health policy issue in many countries. The aim of the study was to identify positive and negative influences on adherence in general medical care, as the largest primary care group, to quantify their frequency of occurrence and correlations and to make them manageable for support measures.

METHODS:

This study is part of a comprehensive investigation in which the adherence processes of 126 patients in five general medical practices was investigated from the consultation to six weeks after it. For this study, semi-structured retrospective telephone interviews concerning the adherence behavior were evaluated. 82 patients (65%) took part in the interviews. These were transcribed and analyzed with a content analysis. As part of a mixed method approach, adherence rates and social variable data were linked to the interview results and statistically evaluated (Chi-Square Tests, Kendall's Tau Correlations).

RESULTS:

In the interviews 495 influences on adherence were mentioned. They were categorised in 26 categories. The most common positive influences were "doctors have a positive effect", "strict adherence to the treatment plan", and "adjustments with doctors and supplements". Among the negative factors, “patients do not want to (continue) treatment”, “adherence does not work as intended” and “other negative influences” were most frequently mentioned. The adherence rate was 45%. Seven negative factors and one positive were significantly more frequently associated with non-adherence. Also patent characteristics showed significant differences.

CONCLUSIONS:

When developing measures to improve adherence in general medical care, the different influences on adherence and their interaction should be taken into account. Not only common but also rare factors should be considered. Adherence barriers in particular have a negative effect on adherence to therapy. Different patient characteristics should be included. The results are discussed in the context of previous scientific knowledge.