Adherence to Long-Term Therapies - Evidence for Action
(2003; 211 pages) View the PDF document
Table of Contents
View the documentPreface
View the documentAcknowledgements
View the documentScientific writers
View the documentIntroduction
View the documentTake-home messages
Open this folder and view contentsSection I - Setting the scene
Open this folder and view contentsSection II - Improving adherence rates: guidance for countries
Close this folderSection III - Disease-Specific Reviews
Open this folder and view contentsChapter VII - Asthma
Open this folder and view contentsChapter VIII - Cancer (Palliative care)
Open this folder and view contentsChapter IX - Depression
Open this folder and view contentsChapter X - Diabetes
Open this folder and view contentsChapter XI - Epilepsy
Open this folder and view contentsChapter XII - Human immunodeficiency virus and acquired immunodeficiency syndrome
Open this folder and view contentsChapter XIII - Hypertension
Close this folderChapter XIV - Tobacco smoking cessation
View the document1. The burden of tobacco smoking
View the document2. Clinical guidelines and therapies available for tobacco smoking cessation
View the document3. Definitions
View the document4. Epidemiology of adherence
View the document5. Factors affecting adherence
View the document6. Interventions for improving adherence
View the document7. Cost, effectiveness and cost-effectiveness of adherence
View the document8. Conclusions
View the document9. References
Open this folder and view contentsChapter XV - Tuberculosis
Open this folder and view contentsAnnexes
Open this folder and view contentsWhere to find a copy of this book

8. Conclusions

Adherence to NRTs and to other treatments for tobacco dependence is very low in the long term (< 40%), but it shows a strong positive correlation with better cessation outcomes. Unfortunately, these long-term cessation outcomes are still unsatisfactorily low (< 20%).The data presented in this chapter are based mainly on clinical trials and three population-based studies. Therefore the data on adherence and cessation rates presented here might be over-optimistic.

In order to improve the accuracy and comparability of measured adherence rates, further research is needed to establish explicit definitions of "adherence to treatment" and treatment dropout. A clearer understanding and distinction between the different factors that influence dropout is also needed.

The patterns of both adherence to therapy and cessation rates over time suggest that interventions for improving adherence would be more cost-effective the earlier they are introduced into the programme (i.e. during the first 3 weeks).

Surprisingly, lack of access to cheap NRTs has been reported as an important reason for smokers in developed countries failing to quit. This is unexpected because the cost of NRTs is usually equivalent to the cost of smoking. Substituting the demand at the same price should not be a reason not to adhere.

There are few data available for identifying effective adherence-promoting interventions, but the use of antidepressant drugs and psychosocial behavioural supports has shown good results. Studies to evaluate the cost-effectiveness of interventions for improving adherence are required.

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