Pharmaceutical prescriptions are core to the treatment of most chronic illnesses, yet only half are taken as prescribed. Despite the high costs of nonadherence to individuals and society, effective adherence-promoting interventions are elusive. This is partly due to the sheer complicity of the issue. There are numerous determinants of adherence, both internal to the patient (intrinsic) and external (extrinsic, e.g., environmental or health system-related factors). Also, the relative importance of these determinants varies between individuals and even within the same individual over time and across treatments, presenting a challenge for intervention design. One complication is that interventions can target several levels: (1) patient (e.g., enhancing motivation and/or ability to adhere), (2) patient-provider interactions (e.g., improving communication and the prescribing process), and (3) the healthcare system (e.g., providing the opportunity to access medication through regulatory approval and co-payment schemes). Here, we focus on level 1: the patient. Although environmental factors are important, the effect of an intervention designed to change them will depend on how they impact on the individual. We describe the Perceptions and Practicalities Approach (PAPA), a pragmatic framework positing that adherence/nonadherence is essentially a produce of individual motivation and ability. Adherence interventions, targeted at any level, will therefore be more effective if tailored to address the perceptions and practicalities underpinning individual motivation and ability. We discuss how PAPA can be operationalized, including the application of theoretical models of illness and treatment representation (Necessity-Concerns Framework and Leventhal’s Common-Sense Model) to address salient adherence-related perceptions.

中文翻译：

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支持长期条件下的药物依从性

药物处方是大多数慢性病治疗的核心，但仅按处方服用一半。尽管对个人和社会的不遵守付出了高昂的代价，但有效的依从性干预措施却难以捉摸。部分原因是该问题的共谋性。在患者内部（内在）和外部（外部，例如与环境或卫生系统相关的因素），依从性的决定因素很多。同样，这些决定因素的相对重要性在个体之间甚至在同一个体内随着时间和治疗的不同而变化，这对干预设计提出了挑战。一种复杂的情况是，干预措施可以针对多个级别：（1）患者（例如，增强动机和/或坚持能力），（2）患者与提供者的互动（例如，改善沟通和处方过程），以及（3）医疗保健系统（例如，通过监管批准和共同付款计划提供机会获得药物​​）。在这里，我们关注级别1：患者。尽管环境因素很重要，但旨在改变环境因素的干预措施的效果将取决于它们如何影响个人。我们描述了感知与实践方法（PAPA），这是一个务实的框架，它假定坚持/不坚持本质上是个人动机和能力的产物。因此，如果针对旨在促进个人动机和能力的观念和实践进行量身定制，则针对任何级别的坚持干预措施都将更加有效。我们讨论了PAPA的运作方式，