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How often have you left the doctors office with your prescriptions and then realized that you had no clue about how often to take each one. Was it supposed to be on an empty stomach or only with food? Was it two, three or four times a day? What happens if you forget whether you took one of the pills? Should you double, just take it when you remember or skip it?

Studies have found poor adherence to the long-term treatment of chronic diseases, like cardiovascular diseases, HIV/AIDS, or depression is an increasing, world-wide problem of striking magnitude. Prescription literacy, understanding the directions on how to take medications, is a problem with doctors find whether they are treating a simple cold or life threatening diseases.

Add the cost of medicines to the confusion about doses and you have a dangerous situation...

Patients Just Stop Taking The Medicine

A number of rigorous reviews have found that in developed countries, adherence among patients suffering from chronic diseases averages only 50%, and it is even lower in developing countries. In Gambia, China, and the United States only 27%, 43% and 51%, respectively, of patients adhere to their medication regimen for high blood pressure.

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%).

These are some of the findings of the World Health Organization’s (WHO) published report entitled Adherence to Long-Term Therapies. Evidence for Action.

"Poor adherence is the primary reason for not achieving the full health benefits medicines can provide to patients. It 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,“ says WHO's Dr. Derek Yach, Executive Director, Noncommunicable Diseases and Mental Health.

In the United States, the United Kingdom and in Venezuela, only 30%, 7% and 4.5%, of treated patients, respectively, had good control of blood pressure. In Sudan, only 18% of non-adherent patients achieved good blood pressure control compared to 96% of those who adhered.

The adherence problem is set to expand as the worldwide burden of chronic diseases increases. Noncommunicable diseases (e.g. cardiovascular disease, cancer, diabetes), 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.

"Better adherence will not threaten health care budgets. On the contrary, adherence to those medicines already prescribed will result in a significant decrease in the overall health budget," says Dr. Eduardo Sabaté, Medical Officer, WHO. “This is due to the reduction in the need for more costly interventions, such as frequent and longer hospitalizations, unnecessary use of emergency room and highly expensive intensive care services.”

Whose Fault Is It?

Patients are often blamed when prescribed treatment is not followed — in spite of the evidence that health-care providers and health systems can greatly influence patients' adherence behavior.

"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 favor of adherence," says Dr. Rafael Bengoa, Director, Management of Noncommunicable Diseases, WHO.

At present, there is no doubt that health care teams are failing to provide behavioral support to patients; they are generally not trained to do so. Moreover, health systems do not enable health professionals to support patients’ behavioral change; they have not been designed for it.

The report was developed using a wide variety of chronic conditions and risk factors and looked for their commonalities. Lessons from those diseases with greater experience on adherence interventions, such as hypertension (high blood pressure), asthma, diabetes, and tuberculosis (Directly Observed Treatment Short Course or DOTS), served as a guide to explore many others of which very little is known, such as cancer, depression, epilepsy, HIV/AIDS and tobacco smoking.

Improving adherence may well result in better health outcomes than making available new technologies. An investment that pays, better adherence will avoid excess costs to already stretched health systems and will improve the lives of people with chronic diseases.

Related Links...

Keeping Up with Medication Dosage and Frequency is Vital to Your Health

Merck Manual - Improving Compliance

Standardizing Medication Labels: Confusing Patients Less. Workshop Summary

Drug Name Confusion: Preventing Medication Errors