International and global news. World Health Organisation Report

Citation

(2003), "International and global news. World Health Organisation Report", International Journal of Health Care Quality Assurance, Vol. 16 No. 7. https://doi.org/10.1108/ijhcqa.2003.06216gab.001

International and global news. World Health Organisation Report

International and global news

World Health Organisation Report

Keywords: WHO, Adherence to treatment, Chronic conditions

A new report from the World Health Organisation (WHO), "Adherence to long-term therapies: evidence foraction", shows that 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.

This report is based on an exhaustive review of the published literature on the definitions, measurements,epidemiology, economics and interventions applied to nine chronicconditions and risk factors. These are asthma, cancer (palliative care),depression, diabetes, epilepsy, HIV/Aids, hypertension, tobacco smoking, and tuberculosis. Adherence problems are observed in all situations where the self-administration of treatment is required, regardless of the type of disease. Adherence to therapies is a primary determinant of treatment success. Poor adherence attenuates optimum clinical benefits and therefore reduces the overall effectiveness of health systems. However, in developed countries adherence amongpatients suffering from chronic diseases averages only 50 per cent. In developing countries, when taken together with poor access to health care, lack of appropriate diagnosis and limited access to medicines, poor adherence is threatening to render futile any effort to tackle chronic conditions, such as diabetes, depression andHIV/Aids.

Dr Derek Yach, executive director, Non-communicable Diseases andMental Health, WHO, said:

"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. Taken together, these direct consequences impair the ability of health-care systems around the world to achieve population health goals."

According to WHO, the adherence problem is set to expand as theworld-wide burden of chronic diseases increases. Non-communicable diseases (e.g. cardiovascular disease, cancer, diabetes), mental health disorders, HIV/Aids and tuberculosis combined represented 54 per cent of the global burden of illness in 2001 and are expected to exceed 65 per cent in 2020.

The report says that, despite evidence to the contrary, there continues to be a tendency to focus on patient-related factors as the causes of problems with adherence, to the relative neglect of provider and health system-related determinants. However, these latter factors, which make up the health-care environment in which patients receive care, have a major effect on adherence. The ability of patients to follow treatment plans in an optimal manner is frequently compromised by more than one barrier, usually related to different aspects of the problem. These include the social and economic factors, the health-care team/system, the characteristics of the disease, disease therapies, and patient-related factors. Solving the problems related to each of these factors is necessary if patients' adherence to therapies is to be improved.

It says that there is no singleintervention strategy or package of strategies that has been shown to be effective across all patients, conditions and settings and so inter-ventions that target adherence must be tailored to the particular illness-related demands experienced by the patient. Accomplishing this means that health systems and providers need to develop means of accurately assessing not only adherence, but also those factors that influence it. Health providers can have a significant impact by assessing risk of non-adherence and delivering interventions to optimise adherence, but to do so practitioners need training inadherence management, and thesystems in which they work must design and support delivery systems that respect this objective.

Further information: The full report, "Adherence to long-termtherapies: evidence for action", is available at www.who.int/chronic_conditions/adherencereport/en/