The Pharmaceutical Journal
Vol 271 No 7256 p9
5 July 2003

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WHO report: "Adherence to long-term therapies. Evidence for action" (more)

Adherence could do more for health than new drugs

Improving adherence to medicines could do more for health outcomes than the introduction of new technologies, according to the World Health Organization.

It says in a report published this week that most health professionals lack the training to change the behaviour of non-adherent patients and suggests that the way health professionals are rewarded for improving adherence should be reviewed.

"Incentives must be created to reinforce the efforts of all health professionals in favour of adherence," said Dr Rafael Bengoa, director, management of non-communicable diseases, WHO.

The report reviews what is known about adherence to long-term therapies and sets out the magnitude of the problem worldwide. For example, it points out that in the United States, China and Gambia only 51 per cent, 43 per cent and 27 per cent, respectively, of patients adhere to their treatment regimen for hypertension. Similar patterns are reported for other conditions such as depression, asthma and HIV/AIDS.

The report also highlights the effects of non-adherence. In the US, the United Kingdom and in Venezuela, only 30 per cent, 7 per cent and 4.5 per cent of treated patients, respectively, had good blood pressure control. In Sudan, only 18 per cent of non-adherent patients achieved good BP control compared with 96 per cent of those who adhered.

Joanne Shaw, director of the UK Task Force on Medicines Partnership, said she welcomed the fact that non-compliance was being recognised as a significant global problem. "The key to improving compliance and making better use of medicines is through involving patients as partners in prescribing decisions and supporting them in medicine- taking. This may mean a shift in the way that health services are delivered," she said. The focus needs to be shifted to providing ongoing support to people taking medicines for chronic illness, by telephone or through pharmacies, she added.

Professor Rob Horne, director of psychology, University of Brighton, was involved in writing the WHO report. He told The Journal that UK initiatives had concentrated on non-intentional non-adherence. "Although valuable, these do nothing to address patients' beliefs about medicines." He added that the challenge for pharmacists would be to engage with the thoughts and beliefs of patients during consultations.

The report "Adherence to long-term therapies. Evidence for action" can be accessed here.