Adherence to Long-Term Therapies - Evidence for Action: Section III - Disease-Specific Reviews: Chapter XIII

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

6. Conclusions

Patients need advice, support and information from health professionals in order to be able to understand the importance of maintaining blood pressure control during the day, to use their drugs rationally, to learn how to deal with missed doses and how to identify adverse events and what to do when they occur. Sharing this responsibility with health professionals is a must - the patient does not need to cope alone.

There is a direct need for research to fill gaps in knowledge on adherence. In general such research should aim at gaining a better understanding of the determinants of adherence discussed above so that effective interventions that address barriers can be developed.

In addition, research should focus on the following important areas:

- validation and standardization of various measures of adherence to prescribed drug therapy and non-pharmacological therapy for hypertension;

- development of valid and reliable questionnaires to obtain information on determinants of adherence;

- investigation of health-related quality-of-life indicators related to patients' adherence to antihypertensive therapy;

- identification of predictors of adherence to pharmacological and non-pharmacological therapy;

- determination of the factors related to behaviour that influence adherence to antihypertensive therapy, such as patient preferences and patient beliefs;

- identifying common risk factors for nonadherence in patients with hypertension, in both developing and developed countries, to study strategies for improving patient adherence;

- understanding of behaviour change principles and mechanisms that promote adherence;

- development of interventions to promote adherence to antihypertensive medication;

- development of materials to involve patients more in managing and regulating their adherence and therefore their hypertension; and

- determination of the reductions in costs and hypertension-related complications resulting from adherence to antihypertensive therapy - issues that are relevant to the needs of patients, managed care organizations and governments.