Adherence to Long-Term Therapies: Evidence for Action

The World Health Organization (WHO) has recently published a comprehensive report entitled Adherence to Long-Term Therapies: Evidence for Action 1. This report focuses on nine chronic conditions and their risk-factors. The conditions reviewed are hypertension, tobacco smoking cessation, asthma, cancer (palliative care), depression, diabetes, epilepsy, HIV/AIDS and tuberculosis. The report reviewed the available literature on the epidemiology of nonadherence worldwide; it stressed the multi-factorial nature of nonadherence, it identified health systems and health care teams as significant determinants to good adherence and discussed the health and economic consequences of nonadherence as well as some strategies for improving it. This report has major relevance for cardiovascular nurses. Cardiovascular disease is and will remain a major challenge for health care professionals and health care systems, and it contributes significantly to the global burden of disease in both developed and developing countries 2. Nonadherence to treatment recommendations in patients with cardiovascular risk-factors as well as patients with cardiovascular disease is widespread, and it is a major factor contributing to poor outcome. Nurses are excellently positioned to target the behavioral dimension of chronic disease management. They can improve outcomes by developing and implementing adherence-enhancing strategies to reduce cardiovascular risk-factors, and to enhance adherence with non-smoking, diet, exercise and medication regimens 3. The value of this WHO report is not only that it comprehensively reviews the current state of the literature including hypertension and tobacco smoking cessation, but also it highlights the need for a multi-disciplinary approach to adherence, emphasizes system factors that need to be addressed in successfully implementing adherence-enhancing strategies. Moreover, it also provides illustrative examples of the ways in which professionals have contributed in their own fields of expertise including cardiovascular care among other fields. This report, therefore, provides an instrument to cardiovascular nurses to expand the behavioral dimension of their patient management strategies, to teach students at undergraduate and graduate level, to guide their research endeavors, to guide policy makers, ultimately with the goal to improve outcomes of populations.