استعرض مصدر Adherence to long-term therapies: evidence for action




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 of time. Initially the
patient was thought to be the source of the “problem of compliance”. Later, the role of the providers 
was also addressed. Now we acknowledge that a systems approach is required. The idea of compliance
is associated too closely with blame, be it of providers or patients and the concept of adherence is a
better way of capturing the dynamic and complex changes required of many players over long periods
to maintain optimal health in people with chronic diseases.

This report provides a critical review of what is known about adherence to long-term therapies. This is
achieved by looking beyond individual diseases. By including communicable diseases such as tuberculo-
sis and human immunodeficiency virus/acquired immunodeficiency syndrome; mental and neurological
conditions such as depression and epilepsy; substance dependence (exemplified by smoking cessation);
as well as hypertension, asthma and palliative care for cancer, a broad range of policy options emerges.

Furthermore, this broader focus highlights certain common issues that need to be addressed with respect
to all chronic conditions regardless of their cause. These are primarily related to the way in which health
systems are structured, financed and operated.

We hope that readers of this report will recognize that simplistic approaches to improving the quality of
life of people with chronic conditions are not possible.What is required instead, is a deliberative approach
that starts with reviewing the way health professionals are trained and rewarded, and includes systemati-
cally tackling the many barriers patients and their families encounter as they strive daily to maintain opti-
mal health.

This report is intended to make a modest contribution to a much-needed debate about adherence.

It provides analysis and solutions, it recommends that more research be conducted, but critically
acknowledges the abundance of what we already know but do not apply. The potential rewards for
patients and societies of addressing adherence to long-term therapies are large. WHO urges the readers 
of this report to work with us as we make the rewards real.


http://www.who.int/chp/knowledge/publications/adherence_full_report.pdf



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