Risk of missed doses underestimated, effective guidance programmes needed

Many patients with chronic conditions do not take as much of their medication as they should. As a result, the effectiveness of the treatment is often suboptimal, and it also becomes more expensive. Until now, the extent to which the guidance of patients could be improved to promote the correct use of medication had been unclear. Researchers at Maastricht University, collaborating with researchers from Wageningen University and the University of Sussex (UK), have now come to the striking conclusion that the percentage of successfully treated patients could increase by approximately forty per cent with optimum guidance. They have written about their findings in a study into the quality of guidance provided in the treatment of HIV in Archives of Internal Medicine (9 February).

Four out of ten patients being treated for chronic conditions do not take their medication as prescribed. They underestimate, for example, the risk of missed doses, have difficulty with integrating the treatment into their lives or simply forget to take the medicine. As a result, the patient does not experiences all the benefits of the treatment. Moreover, this leads to an increase in the medical costs as extra medical examinations are necessary, patients require additional or more expensive medication or they may need to be admitted to hospital.

Large-scale introduction

The researchers compared the results of 31 studies with an average of 200 patients each, carried out in Europe and the United States. These studies looked at the effectiveness of specially-developed guidance programmes for HIV patients as well as the effectiveness of the regular guidance that patients receive as part of the usual medical care in HIV clinics. There are large differences in the quality of care offered by the different clinics. The introduction of the best programme in a clinic with low-quality guidance can double the success of treatment, while the effect of the same programme introduced in a clinic with high-quality care will be considerably smaller. As the best evaluated programme is also very labour-intensive, and therefore not feasible for many hospitals, the researchers recommend the large-scale introduction of patient guidance comparable with the best care already offered by a number of HIV clinics. Trained doctors and HIV nurses can deliver this care within the limited time available for a consultation. The expectation is that the introduction of this in Western HIV clinics will increase the effectiveness of the treatment of HIV by approximately 35%.

The costs of health care in the Netherlands amount to around 70 billion euros a year, and in the United States around 1.5 trillion dollars are spent on treating chronic conditions each year. An increase of "just" five or ten per cent in the effectiveness of the treatment of chronic conditions with medicines could thus reduce health care costs billions of euros per year. The current study also demonstrates the importance of behavioural science research in supporting modern medical treatments.

SOURCE Maastricht University