Adherencia terapeutica

A D H E R E N C E TO LO N G - T E R M T H E R A P I E S

Evidence for action

World Health Organization 2003

WHO Library Cataloguing-in-Publication Data Adherence to long-term therapies: evidence for action. 1. Patient compliance 2. Long-term care 3. Drug therapy – utilization 4. Chronic disease – therapy 5. Health behavior 6. Evidence-based medicine I. WHO Adherence to Long TermTherapies Project II. Global Adherence Interdisciplinary Network. ISBN 92 4 154599 2 (NLM classification: W 85)

© World Health Organization 2003 All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email:bookorders@who.int). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to Publications, at the above address (fax: +41 22 791 4806; email: permissions@who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the WorldHealth Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended bythe World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The World Health Organization does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of itsuse. Printed in Switzerland.

All correspondence should be sent to the author. Eduardo Sabaté, World Health Organization, avenue Appia 20, CH-1211 Geneva 27, Switzerland (sabatee@who.int). Requests for free electronic copies (pdf format only) should be sent to: adherence@who.int

C O N T E N T S
Preface Ackowledgement Scientific writers Introduction Take-home messages Section I – Setting thescene Chapter I – Defining adherence Chapter II – The magnitude of the problem of poor adherence Chapter III – How does poor adherence affect policy makers and health managers? Section II – Improving adherence rates: guidance for countries Chapter IV – Lessons learned Chapter V – Towards the solution Chapter VI – How can improved adherence be translated into health and economics benefits? SectionIII – Disease-specific reviews Chapter VII – Asthma Chapter VIII – Cancer (palliative care) Chapter IX – Depression Chapter X – Diabetes Chapter XI – Epilepsy Chapter XII – HIV/AIDS Chapter XIII – Hypertension Chapter XIV – Tobacco smoking cessation Chapter XV – Tuberculosis Annexes Annex I – Behavioural mechanisms explaining adherence Annex II – Statements by stakeholders Annex III – Table ofreported factors by condition and dimension Annex IV – Table of reported interventions by condition and dimension Annex V – Global adherence interdisciplinary network (GAIN) Where to find a copy of this book Official designated depositories libraries for WHO publications Reference libraries for WHO publications WHO official sales agents world wide Selected WHO publications of related interest Aready-to-use pamphlet for partners willing to promote this book V VII VIII XI XIII 1 3 7 11 17 19 27 39 45 47 59 65 71 87 95 107 115 123 133 135 151 162 166 171 177 179 183 195 197 199

WHO 2003

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Preface
Over the past few decades we have witnessed several phases in the development of approaches aimed at ensuring that patients continue therapy for chronic conditions for long periods...