Barriers to treatment: describing them from a different perspective

Figures & data

Figure 1 Flow diagram of article selection process.

Table 1 Long-term conditions and patient populations covered by selected reviews

	Number of sources reporting
Long-term condition
Hypertension	2
HIV	6
Diabetes (Type I and II)	4
Psoriasis	1
Mental disorders (bipolar and schizophrenia)	1
Cardiac disease	1
Asthma	1
Epilepsy	1
Inflammatory bowel disease	2
Rheumatoid arthritis	1
Cancer	1
Sickle cell disease	1
Tuberculosis	2
Patient population
Not specified	11
Adults	12
Adults and children	2
Children	2
Adolescents	2
Elderly	2

Table 2 Barriers to medication adherence

Barrier to adherence	Number of times cited	Reason for non-adherence	Physician/health system hurdles
Health literacy^Citation4,Citation10,Citation17,Citation22,Citation26,Citation27,Citation29	7	Health care system dimension	Inadequate transmittal of information about condition and medication
Lack of medication knowledge^Citation13,Citation16,Citation19,Citation20,Citation22,Citation27	6		Inadequate transmittal of information about medication
Poor communication on doctor’s part^Citation7,Citation10,Citation13,Citation15^–^Citation17,Citation20,Citation28	8		Not applying effective communication strategies
Do not trust doctor^Citation5^–^Citation7,Citation10,Citation14,Citation16,Citation17,Citation24,Citation27	9	Patient-related dimension	Leaving patients with a lack of trust in the doctor
Concern about adverse effects, avoid side effects^Citation5,Citation6,Citation8,Citation10,Citation12^–^Citation14,Citation17^–^Citation20,Citation24,Citation27	13		Inadequate transmittal of information about medication
Beliefs about medication^Citation12,Citation15^–^Citation17,Citation22,Citation27	6		Inadequate attention to aligning treatment with patient’s beliefs
View on symptoms – felt good so did not take medication^Citation8,Citation14,Citation24,Citation32^–^Citation34	6		Not adequately educating patients about need for treatment of asymptomatic disease
Alcohol/substance misuse^Citation4,Citation6,Citation8,Citation9,Citation19,Citation22,Citation30	7		Inadequate effort to address patient’s substance abuse
Forgot^Citation6,Citation8,Citation11,Citation17,Citation19,Citation20,Citation23,Citation24,Citation31,Citation32,Citation34	11		Inadequate reminder systems put in place
Depression leading to reduced motivation^Citation4,Citation6,Citation8,Citation9,Citation11,Citation13^–^Citation23	16		Inadequate effort to address depression
Cost and lack of insurance coverage^Citation6,Citation10,Citation11,Citation15^–^Citation18,Citation20,Citation22,Citation26,Citation27	11	Social and economic dimension	Prescribing unaffordable medications
Lack of caregiver^Citation6,Citation10,Citation11,Citation16,Citation17,Citation19,Citation24,Citation27	8		Inadequate attention to patient’s support
Secrecy/stigma^Citation5,Citation6,Citation8,Citation9,Citation11,Citation24,Citation26,Citation28	8		Inadequate attention to patient’s beliefs about their condition
Access to health care and resources^Citation4,Citation5,Citation7,Citation10,Citation17,Citation20,Citation24,Citation26,Citation27,Citation29	10		Inadequate provision of service at patient’s location
Cultural beliefs^Citation4,Citation5,Citation7,Citation10,Citation13,Citation17	6		Inadequate attention to aligning treatment with patient’s cultural beliefs
Busy, competing priorities^Citation5,Citation6,Citation8,Citation11,Citation20,Citation24,Citation34	7		Failure to consider patient’s schedule when prescribing medication
Education level^Citation5,Citation14,Citation16,Citation19,Citation22,Citation26,Citation29,Citation30	8		Inadequate transmittal of information about condition and medication
Change to routine^Citation8,Citation15,Citation17,Citation19,Citation20,Citation34	6	Therapy-related dimension	Failure to consider patient’s schedule when prescribing medication
Pill burden, drug regimen too much^Citation8,Citation9,Citation11,Citation15,Citation17,Citation22^–^Citation27,Citation31,Citation34	13		Failure to simplify amount of medications and/or dosing frequency

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