Why So Little Progress in Improving Adherence?

By | October 14, 2013

How can we reenergize efforts to improve medication adherence? Figuring out what’s impeding progress would be a great start. Through looking back to the WHO 2003 report, this post suggests 5 key questions that need to be answered.

Learning from the past to create practical adherence solutions that fit into everyday medical practice.‘Back to the Future’?

It’s over 10 years since the WHO released its report “Adherence to Long-Term Therapies: Evidence for Action”. This critical, evidence-based review remains one of most relevant, most complete documents on the issue of medication adherence. If you read the 2-page summary entitled “Take-home messages”, the statements apply just as strongly today as when they were first written.

While this reflects the great job done by the report’s authors, there’s also a flip side. The fact these take-home statements are just as relevant today as they were 10 years ago is very worrying. It’s an indicator of how little has been achieved to improve medication adherence since January, 2003.

When you look more closely at the information contained in the WHO report, it pretty much covers all the bases. New data in the last 10 years has mostly added support for defined issues, rather than offer new perspectives. For example the key effects of non-adherence are still the same – poorer health outcomes for patients and higher healthcare costs.

What’s changed since 2003 is an even stronger recognition of how much costs associated with non-adherence contribute to overall spiraling healthcare spending. That’s around 12% at latest reckoning. A figure that should give everyone an extra incentive to solve the adherence problem!

Back to the WHO 2003 Report on Adherence

The WHO report identifies improving medication adherence as a means of increasing health system effectiveness. It proposes that improving adherence is a good healthcare investment. And it sets out several important areas where health care professionals can contribute to adherence improvements. For instance:

  • Supporting patients to achieve better adherence; not blaming them for adherence lapses
  • Understanding and identifying the factors and barriers that affect medication adherence
  • Recognizing that an individual patient may have more than one factor or barrier affecting his or her adherence
  • Matching specific adherence-improving interventions with identified patient factors and barriers
  • Using multiple interventions to target several factors or barriers at the same time
    (multi-component solutions)

All of these points are still good today. The report goes on to outline:

  • The wide variety of different factors or barriers that can affect adherence – a comprehensive list divided across 5 categories
  • Thoughts on the most common factors/barriers for each of 9 different chronic disease or treatment areas – asthma, cancer, depression, diabetes, epilepsy, HIV/AIDS, hypertension, smoking cessation, and tuberculosis
  • Suggestions across each of these 9 areas for interventions that match up with the most common factors/barriers

In addition, the document says health systems must evolve to allow physicians, pharmacists, and other healthcare professionals the time, resources, and incentives needed to properly tackle adherence problems.

All this sounds good. So where’s the problem?

The WHO 2003 report provides a great framework around which to build a solid program of adherence improvements. Why has so little progress been made over the past 10 years?

Learning from past lessons to create practical adherence solutions that fit into everyday medical practice.Implications for Future Efforts to Improve Medication Adherence

To succeed in broadly improving adherence we must better understand why efforts to date have been so unsuccessful. Here are a few initial thoughts:

  1. Maybe some key information pieces are still missing?
  2. Perhaps there’s a lack of awareness or understanding among key healthcare stakeholders of what all this information means?
  3. It could be a shortage of commitment or of training among healthcare professionals?
  4. Or possibly insufficient commitment or support from the healthcare system?
  5. It may be due to difficulties in including adherence efforts and actions into the everyday practice of medicine?

What do you think are the reasons for adherence improvement efforts to date not being more effective? Is it one or more of the above? Or are there other factors involved?

What are your views on the reasons why progress has been so slow?

Please share your thoughts!