Medicines will not work if patients do not take them. Nurses know this only too well-successful treatment is not about simply making the diagnosis and giving the prescription to the patient. Encouraging adherence is often when the real work of treatment begins, and the many obstacles to adherence must be addressed in an individualized and compassionate manner for treatment to be successful. Although nurses make significant contributions to patient adherence, their professional training does not prepare them sufficiently to assist patients in making behavioral changes, especially those that encourage adherence to therapy.

Only half of the people who suffer from chronic diseases in the developed world adhere to treatment recommendations 1; in developing countries the rates are believed to be even lower, because of lack of access to treatment and appropriate care. In response, the World Health Organization assembled an international, multidisciplinary team of health care professionals to review what's known about adherence and to suggest solutions. This work resulted in a comprehensive report, "Adherence to Long-Term Therapies: Evidence for Action," which focuses on nine chronic conditions and risk factors: asthma, cancer (palliative care), depression, diabetes, epilepsy, HIV and AIDS, hypertension, tuberculosis, and tobacco smoking. 2

A systematic review by Haynes shows that improving adherence would result in better health outcomes than would the availability of new health care technology. 1 Many nurse-led interventions have resulted in better adherence to recommended standards of care, sometimes with impressive clinical and economic outcomes; for example, nurse follow-up has been shown to improve self-care and glycemic control among patients with diabetes. 3

Chronic diseases are preventable and manageable only if the health care system can assess and support the need for behavioral change in patients, including adherence to effective long-term therapies. The common acute care model does not achieve this. Trained and mandated as patient advocates, care coordinators, and health educators, nurses can act as agents of change in this regard.

Meg Smirnoff, MPH, RN, C-NP

Nancy R. Reynolds, PhD, RN, C-NP

Eduardo Sabate, MD

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