The importance of adherence

What makes the difference between a patient with a chronic condition adhering or not adhering to treatment?

Poor adherence to treatment of chronic disease has been described by the World Health Organization (WHO) as ‘A worldwide problem of striking magnitude’. A number of rigorous reviews have found that, in developed countries, adherence among patients suffering chronic diseases averages only 50%. In developing countries, the rates are even lower1.

“Checking that patients adhere with therapy is not something that many HCPs are confident with”

According to The National Institute for Clinical Excellence (NICE), between a third and a half of all medicines prescribed for long‑term conditions are not taken as recommended2 by UK patients. Adherence is distinct to compliance. Whereas ‘compliance’ implies a passive following of instructions, adherence is active. Although adherence has many factors3, it is dependent on an active 2-way dialogue between healthcare professional (HCP) and patient.

In response to the issue of non-adherence, the Bowel Interest Group, a multi-disciplinary group dedicated to raising the profile of bowel management and supporting healthcare professionals treating patients with bowel conditions, has compiled a report, The Importance of Adherence.

Adherence is a ‘multifactorial phenomenon that can be influenced by various factors’3:

  • social and economic
  • therapy-related
  • disease-related
  • patient-related factors
  • healthcare system-related4.

In the report, Professor Anton Emmanuel, Professor in Neuro-Gastroenterology at University College London & Consultant Gastroenterologist at University College Hospital and the National Hospital for Neurology and Neurosurgery, says: “A multitude of data covering a range of therapies and a range of clinical contexts have shown that it is easier to give advice than it is to monitor that the advice is being followed. This is especially true for chronic conditions, and possibly for bowel conditions where the symptoms are often intermittent. Bowel symptoms are also somewhat taboo, so it is easy to imagine that once symptoms temporarily abate there is a temptation to ignore their existence and ‘return to normal’ without adhering to the initial treatment.”

Professor Emmanuel adds that there may not be any follow-up once a patient has been prescribed their treatment, due to a lack of confidence: “Checking that patients adhere with therapy is not something that many HCPs are confident with. It can be regarded as questioning the professional-patient relationship which is at the heart of the clinical process.”

It all starts with excellent detailing from the pharmaceutical sales professional on the medication, along with an understanding of the factors related to non-adherence, including ‘social and economic factors, the health care team/system, the characteristics of the disease, disease therapies and patient-related factors’5.

This enables the healthcare professional to in turn educate the patient and therefore improve the chances of them adhering to the treatment.

Although adherence is complex, it essentially comes down to three simple things. “What this report summarises are the essential healthcare values: communication, time and empathy,” says Professor Emmanuel.

To get a copy of the report on publication, email

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