Failure to take prescriptions ‘massive’ worldwide problem
The global burden of chronic diseases is being exacerbated by patients’ failure to take their medicine, according to a new WHO report.
Patients being treated for common conditions, from high blood pressure and asthma to depression and HIV/Aids, are not receiving the full benefits of their drugs primarily because they are not taking their long-term self-administered treatment, and this phenomenon has been identified as an increasing world-wide problem.
“This 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,” said Dr Derek Yach the executive director of noncommunicable diseases and mental health at the WHO.
“Taken together, these direct consequences impair the ability of health care systems around the world to achieve population health goals.”
A number of studies have revealed that adherence to treatment in patients from developed countries with chronic diseases averages only 50%, and this falls even lower in developing countries.
In Gambia, China, and the United States only 27%, 43% and 51% of patients adhere to their medication regimen for high blood pressure, and a similar story has emerged for depression (40% to 70%), asthma (43% for acute treatments and 28% for maintenance), and HIV/Aids (37% to 83%).
The problem is set to worsen, as the onslaught of chronic disease will only intensify in the coming decades.
It is thought that the total global burden of noncommunicable diseases, such as cancer, diabetes and heart disease; mental health problems; HIV/Aids; and TB will increase from 54% in 2001 to 65% by 2020.
There is no question that improving the reliability of self-medication regimes will save money, by improving the lives of those with chronic conditions, and preventing more serious complications, which demand expensive treatment.
And better treatment uptake will not threaten health care budgets, WHO medical officer Dr Eduardo Sabat points out.
“On the contrary, adherence to those medicines already prescribed will result in a significant decrease in the overall health budget”.
But crucially, the WHO argues that improving adherence ‘may well result in better health outcomes than making available new technologies’.
As to who is responsible for this poor uptake of treatment, the report says that rather than blaming patients, more heed should be paid to evidence that health-care providers and health systems can greatly influence patients’ behaviour.
At present the WHO observes that health care teams are failing to provide behavioural support to patients, and this is because they are neither trained nor required to do so.
The solution proposed is incentives built into health care system “to reinforce the efforts of all health professionals in favour of adherence,” says Dr Rafael Bengoa, director of management of noncommunicable diseases at the WHO.
