Adherence to Treatment

© Cambridge University Press 2007. Introduction Non-adherence is perceived to be a significant problem in all aspects of healthcare from taking medication to attending counselling sessions. Thousands of research papers have been published on the topic in the last few decades yet non-adherence remains a key challenge in modern healthcare. The main focus of research and reviews has been on adherence to medication prescribed for long-term medical conditions. This is hardly surprising. In affluent countries, most healthcare resources are devoted to the management of chronic diseases such as coronary heart disease, diabetes and asthma. Here, good outcomes depend as much on self-management by the patient as on good medical care and, for most of these conditions, self-management hinges on the appropriate use of medicines. However many patients fail to achieve this. Estimates of the incidence of non-adherence to medication range widely from 2–98%, partly because of differences in the way adherence is defined and measured across studies. Most reviews estimates that 30–50% of medication prescribed for chronic illness is not taken as directed (Meichenbaum & Turk, 1987; Myers & Midence, 1998; World Health Organization, 2003). If the prescription was appropriate, then this level of non-adherence is a concern for those providing, receiving or funding healthcare because it not only entails a waste of resources but also a missed opportunity for therapeutic benefit (DiMatteo et al., 2002). Unfortunately, effective interventions remain elusive (Haynes et al., 2002).