Poor adherence to medication regimens a worldwide problem, says WHO

Poor adherence to the long-term treatment of chronic diseases is an increasing, worldwide problem of striking magnitude, according to the latest report, Adherence to Long-Term Therapies. Evidence for Action.

A number of rigorous reviews have found that in developed countries, adherence among patients suffering from chronic diseases averages only 50%, and the figure is even lower in developing countries. In Gambia, China, and the US the proportion of patients adhering to their medication regimen for hypertension is only 27%, 43% and 51% respectively,and similar patterns have been reported for other conditions such as depression (40-70%), asthma (43% for acute treatments and 28% for maintenance), and HIV/AIDS (37-83%).

'Poor adherence causes medical and psychosocial complications of disease, reduces patients' quality of life, increases the likelihood of development of drug resistance and wastes health care resources,' said Dr Derek Yach, the WHO's executive director, noncommunicable diseases and mental health. 'Taken together, these direct consequences impair the ability of healthcare systems around the world to achieve population health goals.'

The adherence problem is set to expand as the worldwide burden of chronic diseases increases, the report claims. Noncommunicable diseases, mental health disorders, HIV/AIDS and tuberculosis combined represented 54% of the global burden of illness in 2001 and are expected to exceed 65% in 2020.

But it suggests that patients are too often blamed when prescribed treatment is not followed, in spite of the evidence that healthcare providers and health systems can greatly influence patients' adherence behaviour. 'Health professionals witness the need for better patients' adherence to the treatments they are prescribed. Given that the health care system is partially at fault, incentives must be created to reinforce the efforts of all health professionals in favour of adherence,' said Dr Rafael Bengoa, firector, management of noncommunicable diseases, WHO.