Adherence and factor replacement therapy
About one-fifth of adults, young people and children have problems with adherence to factor replacement therapy, according to a systematic review of 16 studies from Canada (Patient Prefer Adherence 2018 Oct 8; doi: 10.2147/PPA.S177624). The analysis, using a framework adapted from research in people with diabetes, found that some studies had focused attention on factors that could not be modified – age, diagnosis – but there were other factors with potential for change, including motivation (experience of bleeding and perceived benefits of treatment), communication and trust in health care providers, negative emotions, understanding of haemophilia and feeling capable of planning. Cost and funding are important issues in countries where full health coverage is not available. The authors conclude that future research should focus on how modifiable factors may explain adherence variability and how these factors can be targeted by psychosocial and behavioural interventions. Transition, including changing to self-care, should be a priority and social factors such as relationships with parents are under-investigated.