(2003; 211 pages)
5. Improving adherence might be the best investment for tackling chronic conditions effectively
Studies consistently find significant cost-savings and increases in the effectiveness of health interventions that are attributable to low-cost interventions for improving adherence. In many cases investments in improving adherence are fully repaid with savings in health care utilization (33) and, in other instances, the improvement in health outcomes fully justifies the investment. The time is ripe for large-scale, multidisciplinary field studies aimed at testing behaviourally sound, multi-focal interventions, across diseases and in different service-delivery environments.
Interventions for removing barriers to adherence must become a central component of efforts to improve population health worldwide. Decision-makers need not be concerned that an undesired increase in health budget will occur due to increasing consumption of medications, because adherence to those medicines already prescribed will result in a significant decrease in the overall health budget due to the reduction in the need for other more costly interventions. Rational use of medicines means good prescribing and full adherence to the prescriptions.
Interventions that promote adherence can help close the gap between the clinical efficacy of interventions and their effectiveness when used in the field, and thus increase the overall effectiveness and efficiency of the health system.
For outcomes to be improved, changes to health policy and health systems are essential. Effective treatment for chronic conditions requires a transfer of health care away from a system that is focused on episodic care in response to acute illness towards a system that is proactive and emphasizes health throughout a lifetime.
Without a system that addresses the determinants of adherence, advances in biomedical technology will fail to realize their potential to reduce the burden of chronic illness. Access to medications is necessary, but insufficient in itself to solve the problem (12).
Increasing the effectiveness of adherence interventions might have a far greater impact on the health of the population than any improvement in specific medical treatments (65).