Understanding compliance issues for daily self-injectable treatment in ambulatory care settings

BACKGROUND The challenge of understanding factors influencing compliance with injectable treatments is critical as injectable biologics/medications become more common. OBJECTIVE Understanding compliance issues for long term self-injectable treatments, using a chronic condition (osteoporosis) as a model. RESEARCH DESIGN A qualitative study to generate hypotheses regarding compliance issues for self-injectable treatments. Semi-structured interview guides were developed and data collected from patients and clinical experts. Findings were analyzed for common themes and a conceptual model of the compliance impact of self-injectable treatments generated. SUBJECTS Six physicians (Rheumatology, Internal Medicine, and Endocrinology) and 22 patients (14% never began treatment, 23% had filled at least one prescription but discontinued treatment, and 63% were currently on treatment) were interviewed. RESULTS Physician and patient factors influenced the compliance process at four distinct time-points: pre-treatment, time treatment recommended, short-term, and long-term. Physician factors that influenced patients' persistence were knowledge about treatment, patient-training resources, and clinical profile/efficacy evaluations. For patients, motivation level, physician message, and clinical profile were key. Logistical issues, minor side effects and injection site issues influenced adherence but not persistence. CONCLUSIONS Compliance is a multifactorial, dynamic process. Both physician and patient factors influence compliance at different points in the process.