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Associate Professor Department of Pharmacy Practice and Science University of Maryland School of Pharmacy Clinical Assistant Professor Department of Pediatrics University of Maryland School of Medicine Baltimore, Maryland
| Edited by Eduardo Sabaté. Published by the World
Health Organization, Geneva, Switzerland, 2003. ISBN 92-4-154599-2.
Paperbound, xv + 198 pp. (26 x 20 cm), $27.
www.who.ch
|
Published Online, April 20, 2004. www.theannals.com, DOI 10.1345/aph.1D425
The World Health Organization (WHO) has published this book as part of their Adherence to Long-Term Therapies Project. This book is one outcome of the work of this global effort. The contributing scientific writers were well selected and represent leading authorities and researchers in the field. The wide-ranging goal of the Adherence Project is to improve adherence in the treatment of chronic conditions worldwide. The overall goal of this report is to influence policy makers to effect local and national healthcare policy change to improve adherence and, ultimately, the patient healthcare system and societal outcomes.
The report focuses on the 4 objectives to (1) provide a summary of the adherence literature to assist with policy development; (2) make healthcare policy makers and managers aware of the consequences of poor adherence, including both physical and economic outcomes; (3) provoke discussion of adherence; and (4) offer a foundation on which policy development can be built and research on the topic enhanced. Although the stated goals seem to be geared more toward healthcare managers and policy makers, the information presented is very relevant to clinicians and researchers as well.
The book has 3 main sections, each divided into chapters, along with 5 annexes (Appendices). Section I, "Setting the Scene," includes 3 short chapters. The first provides the definition of adherence adopted by the WHO project that led to this book's publication and an overview of adherence measurement. Relevant worldwide epidemiology and the impact of poor adherence on health and societal outcomes are covered in the second chapter; and justification of the problem's importance in asthma, hypertension, and diabetes is covered in the third.
The second section, "Improving Adherence Rates: Guidance for Countries," contains 3 referenced chapters covering the consequences of poor adherence and the benefits of improvement. It challenges the establishment to make bold changes to healthcare systems contributing to the problem. The last 2 chapters describe the 5 dimensions of factors contributing to the problem and how interventions geared toward each dimension can help. As in Section I, diabetes, asthma, and hypertension are used as examples to demonstrate translation of enhanced adherence to improvements in economic and health outcomes.
Section III, "Disease-Specific Reviews," contains well-referenced reviews on 9 different conditions: asthma, cancer (palliative care), depression, diabetes, epilepsy, HIV/AIDS, hypertension, tobacco smoking cessation, and tuberculosis. The chapters describe adherence definition and/or measurement, prevalence, associated factors, and recommended interventions. Almost all chapters include recommendations for further research.
The 5 annexes contain diverse information. Annex 1 ("Behavioural Mechanisms Explaining Adherence") is an excellent synopsis of behavioral science and adherence theory. Annex 2 ("Statements by Stakeholders") contains brief statements from a variety of adherence stakeholders representing patient organizations, behavioral medicine, industry, and healthcare professionals. Annexes 3 ("Table of Reported Factors by Condition and Dimension") and 4 ("Table of Reported Interventions by Condition and Dimension") present the impact of socioeconomic, condition, health system, patient, and therapy-related factors on adherence and corresponding interventions for the diseases covered in the book, respectively. Unfortunately, neither is referenced. Members of the Global Adherence Interdisciplinary Network are presented in Annex 5.
The information presented is concise, relevant, and current. References are up-to-date yet include classic studies on adherence in general, as well as specific to the 9 targeted conditions. This organizational approach is logical and presents a wide perspective on the problem of nonadherence first, followed by a discussion of specific adherence issues. Some of the material placed in the annexes might have been better placed in introductory chapters preceding the disease-specific section.
This book does not provide exhaustive discussions of underlying compliance theory, health behavior science, and communication techniques found in conventional texts. For example, Prochaska's transtheoretical model is covered in 3 short paragraphs. One annex ("Behavioural Mechanisms Explaining Adherence: What Every Health Professional Should Know") presents an excellent synopsis of the scientific foundations underlying adherence and provides references directing the reader to primary literature for more detailed coverage. Unlike some books on adherence, however, the text is easy to read and offers not only solid scientific background, but also insights into the causes of nonadherence in patients with specific conditions. Although mental illness and cardiovascular disease present significant challenges to adherence with negative consequences on health outcomes, the only related topics in this book are depression and hypertension. Increased coverage of mental health and cardiovascular disease topics would have been appropriate.
This reasonably priced book will increase awareness of the importance of increasing adherence in patients with a variety of chronic disease states. It provides a broad-based and well-referenced overview of the problem of poor adherence. The disease-specific chapters offer practical interventions for clinicians for improved patient adherence. Researchers and clinicians with research interests will also find the recommendations for areas of future research worthwhile. It would serve as an excellent basic text for undergraduate or professional courses, but may be inadequate as a sole text for graduate-level courses. However, pairing it with primary literature would serve graduate level courses nicely.
Adherence to Long-Term Therapies: Evidence for Action will make an excellent addition to the libraries of healthcare policy makers and managers, busy clinicians, and other professionals who wish to get a very good yet quick overview of basic adherence epidemiology, disease-specific issues for a wide variety of conditions, and practical suggestions regarding improvement of adherence. It is available at a discount for readers in developing countries; the WHO will send a free copy to public libraries on request. The $27 purchase price seems well worth the cost of this text.
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