Management of interventions to improve adherence to therapies and healthy lifestyle for patients with chronic diseases

Improving and maintaining adherence to therapy and healthy lifestyle is critical to successfully managing diseases. Adherence is especially important for patients with chronic diseases, as they require persistent and adequately managed, often lifelong therapies.
Various health management programs aiming to improve adherence are available. This dissertation focuses on some examples, namely case management programs, disease management programs (DMPs) and value based health insurance designs (VBIDs). From the patient’s perspective, health related quality of life (HRQoL) is a particularly relevant health outcome. In contrast to objectively measured health outcomes, such as laboratory values, HRQoL reflects how a patient experiences health. An important challenge of the considered health management programs is that most effects on adherence are small and the effect of adherence on HRQoL is largely unclear. This dissertation contributes to improving these programs with respect to adherence and HRQoL in the following way: On the one hand drivers to and barriers of adherence are identified. On the other hand, the effect of adherence on HRQoL and factors that drive this effect are analyzed.
To pursue these objectives, three research projects with different methodological approaches were completed: an analysis of trail data from the intervention arm of the German KORINNA study with patients after myocardial infarction; a systematic review and meta-analysis on the effect of VBIDs on medication adherence in patients with chronic diseases from evaluation studies from all over the world; and an empiric evaluation study within the German LQ DMP study, where claims data from a large statutory German Health Insurance Fund was linked to data from an EuroQol EQ-5D questionnaire.