TABLE 5-2 Managing Adherence Case Study Contrasting Diabetes and HIV/AIDS

Shared Features

Distinguishing Features

  • Early stages of disease are asymptomatic.

  • Treatment may cause symptoms or increase the risk of other serious problems.

  • Treatment is life long and aimed at preventing deterioration of the patient’s health.

  • Treatment regimen is complex including multiple and concurrently used drugs; timing and dosing is important, coordinated with food intake.

  • Treatment is secondary prevention.

  • Patients must actively participate in treatment.

  • Motivation and adherence vary over time.

  • Patients are disproportionately underserved by health care system and face substantial social and economic stressors that maintain patterns of behavior that place them at risk.

  • The conditions are associated with negative social stigma that pose barriers to adherence.

  • Treatment is costly.

  • HIV is considered a more serious disease or “death sentence.”

  • Treatment goals in diabetes are more flexible than in HIV.

  • Biomarkers of disease control differ with respect to risk; HIV should be undetectable; biomarkers in diabetes are based on a continuum of values.

  • Window of opportunity for beneficial treatment for achieving health benefits from adherence in HIV treatment is shorter than that for diabetes.

  • Side effects of treatment are more of a barrier to HIV adherence than for diabetes.

conditions of care management that support treatment adherence. Especially important among these conditions is care that is based on a collaborative model where the provider’s role is to apply technical knowledge and skill, and to assist patients to develop self-management skills. Continuing contact and support is another critical condition of care that supports sustained adherence. Well-trained providers organized in multidisciplinary teams and skilled to deal with adherence problems are other conditions that support treatment adherence.

Lessons learned from the broader chronic care management literature highlight five important elements of chronic care programs. These elements include evidenced-based planned care, a multidisciplinary team approach, systematic approaches to providing patient information (counseling, education, information feedback), clinical knowledge and expertise (available to

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