Medication compliance: concepts and determinants

摘要

Compliance with prescribed treatments for chronic disease is a major public health concern throughout the world. In addition, in its latest report the World Health Organization (WHO) underlined the fact that poor compliance to long-term treatments is a relentlessly growing problem. A number of rigorous evaluations conducted by the WHO established that in developed countries only 50% of chronically ill patients respected their treatment protocols, and it seems that in developing countries the proportion could be even lower. For example, in Gambia, China and the United States, only 27%, 43% and 51% of patients, respectively, assiduously followed their treatment protocols for arterial hypertension. Moreover, similar trends have been observed for other diseases such as depression (from 40% to 70%), asthma (43% for the treatment of attacks and 28% for maintenance treatment) and HIV/AIDS (from 37% to 83%). Finally, non-compliance can only grow, with the increasing burden of chronic diseases around the world; but, importantly, improvements in compliance will not jeopardize healthcare budgets. On the contrary, compliance with prescribed treatments will lead to a considerable reduction in expenditure thanks to a reduction in the number of expensive interventions, including frequent and prolonged hospitalizations, emergency care or intensive care. In parallel, healthcare professionals are aware of the need to improve compliance with prescribed treatments, and though the healthcare system is partly responsible for the situation, it is clear that due to a lack of adequate training, healthcare teams do not provide enough support to patients. A multidisciplinary approach is therefore necessary to promote compliance and ensure the coordinated action of all healthcare professionals.