Patient not to blame | |
Adherence to long-term therapies: evidence for action. Geneva: World Health Organization, 2003 (xv + 196 pp). ISBN 92 4 154599 2. |
The wise medical practitioner
is well aware that patients often do not keep taking medications, find it hard to keep up with recommendations about diet and exercise, and find it even harder to give up smoking or any other long established habit. This means that the patient may miss out on the full benefits of treatment.
It is reassuring to find that everyday experience is well supported by the evidence. Systematic reviews in developed countries indicate that only 50% of patients continue ongoing therapy for chronic conditions. In developing countries where data are poor, this figure is probably much lower. So it is a worldwide problem and the poor, for many good reasons, are more likely to find it difficult to continue long-term necessary medications and institute lifestyle changes. On the world scene, this means that access to drugs alone does not ensure effective treatment. The term “adherence” is defined in this book as “the extent to which a person’s behaviour — whether taking medication, following a diet or making a change in lifestyle — corresponds with agreed recommendations from a health care provider”. The monograph is intended for use by policy-makers, health managers and practitioners. Introductory chapters summarise the main points. Disease-specific chapters, each written by a group of clinical and behavioural scientists, cover adherence in asthma, cancer, depression, diabetes, epilepsy, HIV/AIDS, hypertension, smoking cessation, tuberculosis and various special topics. Each disease chapter follows a pattern, dealing with evidence on the five interacting dimensions which affect adherence: socio-economic issues, the health system, the condition, the therapy and the patient. Will reading this monograph better equip us to resist the temptation to see adherence, or its absence, as merely another aspect of human behaviour sent to try us? The answer is — probably yes! Many of the principles endorsed are basic to the “quality use of medicines” focus of organisations such as the National Prescribing Service. We are advised not to blame the patient, but to use a multi-disciplinary team approach to support the patient and acknowledge or address system factors. Thus, the principles would probably be familiar — and the book could be useful for teaching purposes. Andrea Mant
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