Patient adherence to orthopaedic treatment plans : toward patient-centered definitions, measurement, and management

Patient adherence to prescribed management protocols is associated with improved function, higher patient satisfaction, and lower complication rates following orthopaedic treatments. While adherence is known to impact patient outcomes, definitions, management and monitoring strategies, and metrics are inconsistent such that factors contributing to non-adherence remain largely overlooked. As such, the overarching goal of this research was to comprehensively characterize patient, healthcare team, and healthcare system factors that contribute to patient non-adherence to orthopaedic management protocols. To accomplish this goal, historical definitions of adherence, factors impacting adherence, and interventions to improve adherence in orthopaedics were reviewed first. A study was then conducted to identify the impact of non-adherence on patient outcomes, and a follow-up study emphasized the impacts of additional adherence-targeted management strategies on rates of non-adherence and associated patient outcomes. To diversify the applicability of this research, the fourth study characterized the range of biopsychosocial and demographic factors that impacted no-show rates in an orthopaedic trauma patient population. Finally, adherence was characterized through the lens of the healthcare team using a qualitative study design, resulting in creation of the first Barriers and Enablers To Adherence (BETA) model. The data presented herein highlights a critical unmet need in healthcare for evidence-based, patient-centered mechanisms to individualize care such that adherence becomes a partnership between patients and healthcare teams. The overarching goal of the dissertation research was met by characterizing the range of factors impacting adherence and working toward a framework for moderating non-adherence going forward. This foundational work will allow for future programmatic research aimed at developing, validating, and implementing management strategies that empower healthcare teams to effectively equip patients for adherence, leading to optimized patient outcomes following orthopaedic treatments.