In recent years, the ageing of the Polish population has accelerated. The consequences of this process are leading to a sharp increase in the number of people with chronic conditions, in particular patients with multimorbidity.
Multimorbidity is a factor contributing to unsystematic treatment, i.e. to the phenomenon known as non-adherence to therapeutic recommendations. International comparative studies indicate that the frequency of non-adherence to therapeutic recommendations is particularly high in Poland. Despite this, to date, no large-scale interventions have been introduced in our country to improve the regularity of patients' treatment. With this in mind, at the S. Jasiński Provincial Rehabilitation Hospital in Zakopane, it was decided to develop and pilot a multidisciplinary programme to improve patients' adherence to therapeutic recommendations. The aim of this paper is to present the assumptions, development, final form and results of this programme.
Methods: Using the strategic management methodology, the main operational objective, and supporting objectives of the project were defined. Patients aged 60 and over from all over Poland were included in the project, entering the hospital for a cycle of inpatient rehabilitation treatment in 2016-2017, for a total of 1,000 people. Using elements of teamwork and theoretical training provided by an expert, a multidisciplinary medical team was formed to detail and implement the intervention implemented as part of the programme, including, among other things, the development of a management model for working with elderly patients and the preparation of innovative tools necessary for the implementation of the project - a pre-hospital evaluation questionnaire, an individual therapy plan for patient 60+ and a checklist to be used to improve adherence to therapeutic recommendations by each programme implementer, as well as a survey tool to assess the sustainability of the programme results.
Results: The usefulness of the individual elements of the intervention provided as part of the programme was shaded very highly (74.0% of the respondents considered the intervention provided by the dietician as "very useful" or "useful", for the interventions provided by the physiotherapist it was - 81.3%, the psychotherapist - 64.7%, the nurse - 76.7% and the doctor for therapy - 80.0%). In addition, in the assessment of the patients who entered the programme, the individualised therapy provided by the medical staff (dietician, physiotherapist, psychotherapist, nurse and doctor) had a positive effect on adherence to treatment recommendations in terms of diet, physiotherapy, psychotherapy, nursing and drug therapy. This fact is confirmed by the results of the study - when asked about the impact of the individual work of the medical staff, patients rated that adherence to treatment recommendations became "much easier" or "easier" for them in 67.3%, 77.3%, 56.0%, 74.0% and
77,3%).
Conclusions: The comprehensive programme to improve adherence of older patients developed in this project provides an example of a solution to the problem of non-adherence to treatment by multi-disease burdened older people. The effectiveness of this programme requires objective evaluation in a clinical trial setting. This programme, with appropriate modifications, can be adopted for other conditions.
https://repozytorium.ka.edu.pl/bitstream/handle/11315/24985/Milaniak_Ocena_stopnia_przest recommendations_therapeutic_2014.pdf?sequence=1&isAllowed=y