Strategies to promote adherence to clinical recommendations for chronic diseases in primary healthcare

<title>Abstract</title> <p>Background Non-communicable chronic diseases represent a major global public health challenge. Their effective long-term management depends on treatment compliance, with poor adherence leading to suboptimal disease control, increased hospitalizations, and higher healthcare costs. This study aimed to establish consensus on recommendations to strengthen treatment adherence among individuals with chronic conditions in primary health care in Chile, integrating the perspectives of patients and healthcare professionals. Methods A qualitative study using a two-stage methodology was conducted in Chilean primary health care. In Stage 1 (diagnostic phase), focus group discussions including patients with chronic conditions and primary healthcare professionals explored barriers and facilitators to treatment adherence. In Stage 2 (consensus phase), three Delphi rounds established consensus on recommendations. The Tanahashi health service coverage model was applied as a conceptual framework to structure data coding and to organise the analysis of recommendations. Results A total of 11 participants took part in the focus groups during Stage 1, generating statements on barriers and facilitators to treatment adherence. In Stage 2, 37 participants from different regions of the country completed three Delphi rounds. Consensus was reached on 48 recommendations across the Tanahashi dimensions. The highest priority recommendations emphasized strengthening patient’s active role in self-care, improving communication and trust in the patient–provider relationship, enhancing care coordination within primary healthcare teams, and addressing structural barriers related to workforce capacity, infrastructure and service availability. Digital health tools were also identified as potential strategies to improve access and support treatment adherence. Conclusions Participants gave priority to empowering patients in self-care, strengthening patient-provider communication and trust, improving care coordination within primary care, addressing structural system constraints, and leveraging digital health tools to enhance access and support treatment adherence. The recommendations identified may inform health policies and system strategies to strengthen chronic disease management in the Chilean primary healthcare.</p>