Chronic therapeutic non-adherence: Toward a new nosological entity

Area of Science:

• Clinical Medicine
• Medical Syndromes
• Public Health

Background:

• Therapeutic non-adherence (TNA) significantly increases chronic disease burden.
• Currently, TNA is primarily viewed as a behavioral issue, not a pathological process.

Purpose of the Study:

• To assess if chronic TNA meets criteria for a distinct clinical syndrome using the Bradford Hill criteria.
• To explore the implications of reclassifying TNA as a nosological entity.

Main Methods:

• Conceptual analysis applying the Bradford Hill criteria to existing evidence on TNA.
• Review of associations between TNA and health outcomes, pathophysiological plausibility, and intervention effects.

Main Results:

• Consistent associations found between TNA and increased morbidity, mortality, and healthcare costs.
• Evidence supports TNA's temporality, specificity, dose-response relationship, and biological correlates, suggesting pathophysiological plausibility.
• Intervention studies indicate modifying TNA impacts disease trajectory.

Conclusions:

• Chronic TNA exhibits features supporting its classification as a clinical syndrome.
• Reclassifying TNA could enable systematic identification, coding, and targeted interventions, reducing stigma.
• Further research is needed for consensus criteria and validation before formal classification.