ABC Project update. in the field of adherence research. toward better terminology and taxonomy

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1 ABC Project update toward better terminology and taxonomy in the field of adherence research Assoc. Prof. Przemyslaw Kardas, MD PhD Director, First Department of Family Medicine Medical University of Lodz, Poland

2 Non-compliance draws more and more attention Number of publications with key word patient compliance [MeSH] in PubMed database 2

3 Why non-compliance become a public health issue? Non-compliance rates in both long-term and short-term treatments reach 50% of patients Non-compliance was called a worldwide problem of striking magnitude (WHO, 2003) Non-compliance is a major barrier for realising the benefits of evidence-based therapies 3

4 Impact of non-compliance on outcome Percentage change in compliance Percentage change in outc come Hughes DA et al. Health Econ. 2001; 10(7):

5 Impact of non-compliance on mortality 5 Simpson SH. BMJ. 2006; 333(7557): 15.

6 Non-compliance is a global problem Hypertension Diabetes Antibiotics TB HIV 6

7 Why non-compliance become a public health issue? Non-compliance rates in both long-term and short-term treatments reach 50% of patients Non-compliance was called a worldwide problem of striking magnitude (WHO, 2003) Non-compliance is a major barrier for realising the benefits of evidence-based therapies Lack of effective policies toward the problem of non-compliance at both national and European levels 6

8 What s new? 1. Economic situation 2. Demography 3. Role of pharmaceutical industry 8

9 Economic situation: world crisis 9

10 Economic situation: compliance is a solution? Estimates of the current cost of drug-related morbidity in the USA, including poor adherence, rech $290 billion annually (13% of total health care expenditures) 10 Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease, NEHI Report, 2009.

11 Is economy a solution for non-compliance? Cost-related prescription nonadherence in the United States and Canada United States vs Canada (adults): 23.1% vs 8.0%, P < Seniors vs younger adults (USA): 9.2% vs 25.8%, P < Uninsured vs insured (USA): >7 times 11 Kennedy J, Morgan S. Clin Ther Jan;31(1):213-9.

12 European demographic challenge 2009 Poland United Kingdom

13 The older the population the more prevalent the chronic conditions 13 Wolf-Maier K et al., JAMA. 2003; 289(18):

14 Role of the pharmaceutical industry Awareness of compliance No new antiinfetcives in the manufacturing pipeline 14

15 Aim of the ABC Project to produce evidence-based policy recommendations for European policymakers for improved patient compliance and subsequent better use of medication, in order to obtain safer, more effective and cost-effective use of medicines in Europe 15

16 Aims of the ABC Project Objective 1 European consensus on terminology used in the field of deviations from assigned treatment and relevant taxonomy 16

17 Terminology muddle Compliance Adherence Concordance Persistence Discontinuation etc. 17

18 Terminology muddle 18 Urquhart J & Vrijens B, Eur J Hospital Pharm Sci 2005;11(5):103-6.

19 How much compliance is enough? > 80% 100% % % % > 88% Wu JR, et al. Am Heart J 2009 Feb;157(2):

20 How to measure and report compliance? A systematic review of how medication adherence to chronic medication was assessed and reported in recently published RCTs: CONCLUSION: There is important variability in the assessment and reporting of medication adherence in published RCTs of pharmacological treatments of selected chronic diseases ( ) Standardization is advisable to allow for comparisons among studies. 20 Gossec L et al.. Am J Med Sci Oct;334(4):

21 How to measure and report compliance? (2) A systematic review of the relationship between compliance and achieved blood pressure (Facts and fiction of poor compliance as a cause of inadequate blood pressure control: a systematic review.) AUTHORS CONCLUSION: Although poor compliance is assumed to be an important explanation for inadequate blood pressure control, any convincing empirical evidence to support this hypothesis is currently lacking. The relationship between patient compliance and blood pressure control has not yet been properly established. Taking compliance and/or correct dosing were used in 20/30 studies 21 Wetzels GE et al. J Hypertens Oct;22(10):

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23 Visit ABC Project web site at 23