Factors associated with patient adherence to medical recommendations during a health crisis
Anat Reiner-Benaim, Shimon Amar
Abstract
Patient non-adherence to medical recommendations is associated with significant economic and health consequences, particularly in chronic diseases. While less studied, similar implications are also observed for short-term antibiotic treatment non-adherence.
Introduction
The medical literature is replete with research on adherence to medical treatment, especially in chronic diseases, and less prominently regarding antibiotic therapy [1,2] Adherence, defined as the extent to which a patient's actions coincide with the prescribed treatment regimen/advice, plays a pivotal role in achieving optimal health outcomes [3–5].
Methods
Data were collected retrospectively from the database of Clalit Health Services (CHS), the largest HMO in Israel, on all visits to a PCP in Southern Israel between January 1, 2018, and December 31, 2022, that resulted in a diagnosis of either cough, fever, or both, in accordance with the International Classification of Diseases (ICD-9).
Results
In total, 609,823 visits to PCP by 216,819 individuals complied with the cohort definitions (Table 1). The mean age across all visits was 22.5 (±26.4) years, and 51.8% of all visits were by females (Table 1).
Discussion
This large-scale retrospective cohort study investigated patient adherence, as defined by response to diagnostic tests referrals and to antibiotic prescriptions. It compared adherence patterns prior to the COVID-19 pandemic period with those observed during and after social restrictions and lockdowns.
Acknowledgments
We thank the Southern District team of Clalit Health Services and Adi Gan-El Cherry for their help with data collection.
Citation: Reiner-Benaim A, Amar S (2026) Factors associated with patient adherence to medical recommendations during a health crisis. PLoS One 21(3): e0345375. https://doi.org/10.1371/journal.pone.0345375
Editor: Benjamin M. Liu, Children's National Hospital, George Washington University, UNITED STATES OF AMERICA
Received: September 3, 2024; Accepted: February 25, 2026; Published: March 19, 2026
Copyright: © 2026 Reiner-Benaim, Amar. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The data cannot be shared publicly since it contains potentially identifying information (location of clinic, visit dates) and sensitive patient information (referrals to diagnostic tests, prescriptions to antibiotics, diagnoses) and thus ethical restrictions were imposed by the Research Ethics Committee. The data are owned by a third-party organization (CHS - Clalit Health Services), and were made accessible only to the searchers, and only during the research time-window, via CHS virtualization desktop infrastructure (VDI) cloud system, with a personal username and password. Data are available from the Institutional Data Access of CHS (contact via DataDromCommittee@clalit.org.il) for researchers who meet the criteria for access to confidential data.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
