Barcelona, November 23rd 2016.– Half of Spanish patients suffering from chronic illnesses do not correctly follow the prescribed pharmacotherapeutic treatment. This data, which emerges from a survey of 1,400 patients commissioned by Farmaindustria, reflects the real scale of the problem of the lack of adherence to treatments, which has consequences both for the health of the patient and for the quality and sustainability of the health system. To address this challenge, the Treatment Adherence Plan (responsible use of medicine), has been presented in Barcelona, a document which was prepared by scientific medical societies, pharmaceutical and nursing societies, patient representatives and professional experts, and promoted by Farmaindustria, is at the disposal of the sanitary authorities for its study and eventual application.

The Plan proposes a complete work strategy that arises from the vision of both healthcare professionals and patients. It is an unprecedented project, both integral and inclusive, transversal, ambitious and with the use of being applicable and continuous. In short, it is a proposal that civil society brings to public health administrations with the objective of improving the quality of health care and, above all, the health of patients.

Fifteen scientific medical societies, pharmaceutical and nursing societies, in addition to the Federation of Scientific and Medical Associations of Spain (Facme), have worked for more than a year on the Plan along with those responsible for the Platform of Patient Associations and the Spanish Forum Of Patients and other experts in the field, all of them on the so-called Impulse Committee.

The lack of adherence to treatments is of concern to health workers, and the survey commissioned by Farmaindustria amongst chronic patients as the basis for the Plan notes the relevance of the problem, which is related to very different variables, such as the complexity of the treatments or their long duration, the relationship between patients and nurses, absence of symptoms, greater or lesser knowledge of the disease, psychological factors and lack of family or care support, amongst others. Thus, according to the data obtained, 71.2% of those under 45 years of age not adequately comply with the medication prescribed by the physician, the majority of non-compliant patients are those with a high school education (60%) or higher education (56.1%), and on the other hand, the most compliant of chronically ill patients are the eldest (63.9% of those who are over 65 years of age), who live in rural areas with no middle or higher education (55.9%).

Concrete actions

The Treatment Adherence Plan accepts such complexity and tries to respond to it. It is structured in six pillars, which are deployed into 18 initiatives which, are then in turn, divided into 26 actions. Its development gives rise to a series of proposals and activities that intend to involve the different agents (administrations, health professionals, patients and industry) in their execution. Several measures were proposed, from ensuring that the right amount of time is given in the medical consultation to ensure optimal prescription, to strengthening coordination between different professionals and levels of care (doctors, nurses and pharmacists) to achieve a good pharmacotherapeutic follow-up.

In addition, it has been proposed that training on adherence to treatment in bio-sanitary careers be incorporated; add a unit within the electronic prescription that allows health professionals to alert their colleagues to the non-compliant patient; create an algorithm to detect the lack of therapeutic adherence; homogenize indicators of measurement for adherence in order to better monitor the results of the Plan; enhance the education around therapy for chronically ill patients; strengthen the role of trainers within patient associations, or launch a platform to boost research and studies in this area.

The initiative includes a model on the economic and health impact of adherence that has already been applied to pathologies of high prevalence (COPD, type 2 diabetes, cardiovascular disease and major depression) and provides strong data on the potential improvements in terms of health, and possible savings that could lead to improved adherence. For example, the model demonstrates that increasing adherence to treatments with cardiovascular disease (the leading cause of death in Spain) by 10 percentage points would prevent 8,700 deaths and up to 7,650 cardiovascular events, and would directly save €75M in health expenditure of. At present, the adherence of patients with this disease stands at 56%.

“This Plan is a good starting point and has the cooperation of patients, which is fundamental. It is time to talk about the management of the health system together with the patients: if we are the center of the system, we want to participate in the decisions that affect us, especially to make ourselves responsible for these decisions” – says Esther Sabando, secretary of the Platform Patient Organizations. “We must remember that, in order for this Plan to be fulfilled, patients need tools, training and information, and, of course, to be able to participate in making decisions about treatment, it is fundamental to know if we can then comply or not.”

“One of the strengths of the Plan is that it is a proposal that derives from the collaboration between the different groups of health professionals and patients” – adds Cristina Avendaño, coordinator of its Impulse Committee – “with the capacity to promote and facilitate the Progress of projects and cross-cutting initiatives. It is a plan that structures the possible actions and strategies for improving adherence, in a way that enhances the integration of the projects of the various institutions and groups and facilitates the synergies between them.”

According to Humberto Arnés, CEO of Farmaindustria, “lack of adherence is a healthcare issue, which is of concern to everyone, and therefore also to industry. The best medicine does not fulfill its valuable function if it is not used properly. That was one of the reasons why we wanted to promote this Plan, a civil society initiative that puts itself at the service of healthcare authorities.”