Adherence to Long-Term Therapies - Evidence for Action: Section II - Improving adherence rates: guidance for countries: Chapter IV - Lessons learned: 5. Improving adherence might be the best investment for tackling chronic conditions effectively

Adherence to Long-Term Therapies - Evidence for Action
(2003; 211 pages)

Table of Contents

Preface
Acknowledgements
Scientific writers
Introduction
Take-home messages
Section I - Setting the scene
	Chapter I - Defining adherence
		1. What is adherence?
		2. The state-of-the-art measurement
		3. References
	Chapter II - The magnitude of the problem of poor adherence
		1. A worldwide problem of striking magnitude
		2. The impact of poor adherence grows as the burden of chronic diseases grows worldwide
		3. The poor are disproportionately affected
		4. References
	Chapter III - How does poor adherence affect policy-makers and health managers?
		1. Diabetes
		2. Hypertension
		3. Asthma
		4. References
Section II - Improving adherence rates: guidance for countries
	Chapter IV - Lessons learned
		1. Patients need to be supported, not blamed
		2. The consequences of poor adherence to long-term therapies are poor health outcomes and increased health care costs
		3. Improving adherence also enhances patient safety
		4. Adherence is an important modifier of health system effectiveness
		5. Improving adherence might be the best investment for tackling chronic conditions effectively
		6. Health systems must evolve to meet new challenges
		7. A multidisciplinary approach towards adherence is needed
		8. References
	Chapter V - Towards the solution
		1. Five interacting dimensions affect adherence
		2. Intervening in the five dimensions
		3. References
	Chapter VI - How can improved adherence be translated into health and economic benefits?
		1. Diabetes
		2. Hypertension
		3. Asthma
		4. References
Section III - Disease-Specific Reviews
	Chapter VII - Asthma
		1. Defining nonadherence to asthma therapy
		2. Rates of adherence to inhaled corticosteroids and other drugs for the prevention of asthma
		3. Forms of nonadherence
		4. Factors associated with adherence to asthma treatment
		5. Adherence in special populations
		6. Interventions to improve adherence to asthma therapy
		7. Discussion
		8. Conclusions
		9. References
	Chapter VIII - Cancer (Palliative care)
		1. Definitions and epidemiology of adherence
		2. Factors and interventions affecting adherence
		3. Conclusions
		4. References
	Chapter IX - Depression
		1. Research methods: measurement of adherence and sampling
		2. Rates of adherence
		3. Predictors of adherence
		4. Interventions to improve adherence
		5. Clinical implications and need for further research
		6. References
	Chapter X - Diabetes
		1. Introduction
		2. Treatment of diabetes
		3. Definition of adherence
		4. Prevalence of adherence to recommendations for diabetes treatment
		5. Correlates of adherence
		6. Interventions
		7. Methodological and conceptual issues in research on adherence to treatment for diabetes
		8. Conclusions
		9. References
	Chapter XI - Epilepsy
		1. Introduction
		2. Adherence to epilepsy therapy
		3. Epidemiology of adherence
		4. Factors affecting adherence and interventions used to improve it
		5. Conclusions
		6. References
	Chapter XII - Human immunodeficiency virus and acquired immunodeficiency syndrome
		1. Types of nonadherence
		2. Challenges in assessing adherence
		3. Predictors of adherence
		4. A framework for interventions to increase adherence
		5. Conclusions
		6. References
	Chapter XIII - Hypertension
		1. Prevalence of adherence to pharmacotherapy in patients with hypertension
		2. Impact of adherence on blood pressure control and cardiovascular outcome
		3. Adherence to non-pharmacological treatment
		4. Factors contributing to adherence
		5. Interventions for improving adherence
		6. Conclusions
		7. References
	Chapter XIV - Tobacco smoking cessation
		1. The burden of tobacco smoking
		2. Clinical guidelines and therapies available for tobacco smoking cessation
		3. Definitions
		4. Epidemiology of adherence
		5. Factors affecting adherence
		6. Interventions for improving adherence
		7. Cost, effectiveness and cost-effectiveness of adherence
		8. Conclusions
		9. References
	Chapter XV - Tuberculosis
		1. Definition of adherence
		2. Factors that influence adherence to treatment
		3. Prediction of adherence
		4. Strategies to improve adherence to treatment
		5. Questions for future research
		6. References
Annexes
	Annex I - Behavioural mechanisms explaining adherence
		1. Introduction
		2. The nature of poor adherence
		3. Determinants of adherence
		4. Models
		5. Interventions
		6. Conclusions
		7. References
	Annex II - Statements by stakeholders
		1. Family, community and patients' organizations
		2. Behavioural medicine
		3. General practitioners/family physicians
		4. Industry
		5. Nurses
		6. Pharmacists
		7. Psychologists
	Annex III - Table of reported factors by condition and dimension
	Annex IV - Table of reported interventions by condition and dimension
	Annex V - Global Adherence Interdisciplinary Network (GAIN)
		Scientists
		Professional, industry and patients' organizations
		Policy-makers
Where to find a copy of this book
	Officially designated depository libraries for WHO publications
	Reference libraries for WHO publications
	WHO official sales agents world wide
	Selected WHO publications of related interest
	A ready-to-use pamphlet for partners willing to promote this book

5. Improving adherence might be the best investment for tackling chronic conditions effectively

Studies consistently find significant cost-savings and increases in the effectiveness of health interventions that are attributable to low-cost interventions for improving adherence. In many cases investments in improving adherence are fully repaid with savings in health care utilization (33) and, in other instances, the improvement in health outcomes fully justifies the investment. The time is ripe for large-scale, multidisciplinary field studies aimed at testing behaviourally sound, multi-focal interventions, across diseases and in different service-delivery environments.

Interventions for removing barriers to adherence must become a central component of efforts to improve population health worldwide. Decision-makers need not be concerned that an undesired increase in health budget will occur due to increasing consumption of medications, because adherence to those medicines already prescribed will result in a significant decrease in the overall health budget due to the reduction in the need for other more costly interventions. Rational use of medicines means good prescribing and full adherence to the prescriptions.

Interventions that promote adherence can help close the gap between the clinical efficacy of interventions and their effectiveness when used in the field, and thus increase the overall effectiveness and efficiency of the health system.

For outcomes to be improved, changes to health policy and health systems are essential. Effective treatment for chronic conditions requires a transfer of health care away from a system that is focused on episodic care in response to acute illness towards a system that is proactive and emphasizes health throughout a lifetime.

Without a system that addresses the determinants of adherence, advances in biomedical technology will fail to realize their potential to reduce the burden of chronic illness. Access to medications is necessary, but insufficient in itself to solve the problem (12).

Increasing the effectiveness of adherence interventions might have a far greater impact on the health of the population than any improvement in specific medical treatments (65).