Adherence therapy for people with Parkinson's disease

Daley, David James (2013) Adherence therapy for people with Parkinson's disease. Doctoral thesis, University of East Anglia.

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Introduction: Medication non-adherence is prevalent in Parkinson’s disease (PD). However, factors associated with non-adherence are unknown. Despite interventions to improve medication adherence being investigated in long-term conditions, few studies have focused on PD. Adherence Therapy (AT) is a novel, patient-centred approach to maximising adherence that has shown benefit in other chronic conditions.
Aim: To investigate the efficacy of AT for improving medication adherence and quality of Life (QoL) in people with PD.
Methods: To achieve the above aim I conducted a systematic review to identify factors associated with medication non-adherence, followed by a Cochrane systematic review on interventions for improving medication adherence in PD. I then tested the efficacy of AT in PD in a randomised controlled trial (RCT). Semistructured interviews were used to explore patients’ experiences of receiving AT.
Results: Mood disorders, cognition, poor symptom control/QoL, younger age/longer disease duration, regimen complexity/polypharmacy, risk taking behaviours, poor knowledge of PD/education, lack of spouse/partner, low income, desire to maintain employment and gender were identified as factors associated with non-adherence in PD. Only one study previously investigated an intervention (didactic educational material) for improving medication adherence in PD, according to my Cochrane systematic review.
Seventy-six patients and 46 spouse/carers completed the RCT (CAAT-PARK). At week-12 follow-up the active treatment group significantly improved in adherence and QoL compared to the treatment as usual group. Thematic analysis of interviews from 10 patients and 3 spouse/carers suggested that positive effects and attributes of AT may be important for the success of AT. Furthermore, the findings suggested that the mechanism of AT may be bi-directional and associated with improved confidence and self-efficacy.
Conclusions: Adherence Therapy improved medication adherence and QoL in PD. A larger pragmatic trial to test the efficacy and cost effectiveness of Adherence Therapy with a control group placebo intervention is required. ISRCTN07830951

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Users 2593 not found.
Date Deposited: 09 Apr 2014 13:21
Last Modified: 09 Apr 2014 13:21


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