Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University - Sofia, Sofia, Bulgaria.
Department of Endocrinology, University Specialized Hospital for Active Treatment of Endocrinology (USHATE) "Acad. Ivan Penchev," Medical University - Sofia, Sofia, Bulgaria.
Front Public Health. 2021 Jul 14;9:693409. doi: 10.3389/fpubh.2021.693409. eCollection 2021.
Adherence to therapy is one of the most important elements during the therapeutic process ensuring the predefined therapeutic outcomes. The aim is to analyze the need and importance of treatment adherence guideline for acromegaly patients and the possibilities for its development and implementation in Bulgaria. A set of methods was applied: (1) a literature review in the electronic database for identification of articles and guidelines related to adherence and acromegaly; (2) analysis of Bulgarian legislative documents; (3) a pilot study for assessment of the level of treatment adherence among hospitalized Bulgarian acromegaly patients in 2018; (4) a plan for development and implementation of specific guideline was created entitled BULMEDACRO - BULgarian guideline for MEdication aDherence assessment and improvement in ACROmegaly. No specific guidelines for evaluation, monitoring, reporting and/or improving adherence in acromegaly patients has been found in the literature. Requirements for regular assessment of the level of adherence, application of appropriate methods for improvement and monitoring are not sufficiently formulated and mandatory. The pilot study confirmed that therapy adherence among Bulgarian patients with acromegaly is relatively high as almost 90% of patients report that they strictly comply with their prescribed treatment regimen. It is necessary, however, a specific guideline focused on the methods for assessment and improvement of adherence, in order to ensure monitoring and follow-up of acromegaly patients. Patients with acromegaly should be the focus of specially designed national programs, initiatives and/or guidelines for regular evaluation and improvement of the adherence level. Despite the difficulties and the lack of an adequate legal basis, successive steps initiated by different stakeholder are needed.
治疗依从性是治疗过程中最重要的因素之一，可确保达到既定的治疗效果。本研究旨在分析制定和实施保加利亚肢端肥大症患者治疗依从性指南的必要性和重要性。采用了以下方法：（1）在电子数据库中进行文献综述，以确定与依从性和肢端肥大症相关的文章和指南；（2）分析保加利亚立法文件；（3）2018 年对住院保加利亚肢端肥大症患者进行治疗依从性评估的试点研究；（4）创建了一个名为 BULMEDACRO（保加利亚肢端肥大症药物依从性评估和改善指南）的特定指南的开发和实施计划。在文献中没有发现针对评估、监测、报告和/或改善肢端肥大症患者依从性的具体指南。定期评估依从性水平、应用适当的改善方法和监测的要求没有得到充分阐述和强制规定。试点研究证实，保加利亚肢端肥大症患者的治疗依从性相对较高，因为近 90%的患者报告他们严格遵守医嘱。然而，需要有一个专门针对依从性评估和改善方法的具体指南，以确保对肢端肥大症患者进行监测和随访。肢端肥大症患者应成为专门设计的国家计划、倡议和/或指南的重点，以定期评估和改善依从性水平。尽管存在困难和缺乏适当的法律依据，但需要采取不同利益相关者发起的连续步骤。
