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ADHERENCE TO LONG-TERM THERAPIES
Evidence for action
World Health Organization 2003
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WHO Library Cataloguing-in-Publication Data
Adherence to long-term therapies:evidence for action.
1.Patient compliance.2.Long-term care.3.Drug therapy – utilization.4.Chronic disease – therapy.
5.Health behavior.6.Evidence-based medicine.I.WHO Adherence to Long Term Therapies Project.
II.Global Adherence Interdisciplinary Network.
ISBN 92 4 154599 2
(NLM classification:W 85)
© World Health Organization 2003
All rights reserved.
Publications of the World Health Organization can be obtained from Marketing and Dissemination,
World Health Organization,20 Avenue Appia,1211 Geneva 27,Switzerland (tel:+41 22 791 2476;
fax:+41 22 791 4857;email:bookorders@who.int).Requests for permission to reproduce or translate
WHO publications – whether for sale or for noncommercial distribution – should be addressed to
Publications,at the above address (fax:+41 22 791 4806;email:permissions@who.int).
The designations employed and the presentation of the material in this publication do not imply the
expression of any opinion whatsoever on the part of the World Health Organization concerning the
legal status of any country,territory,city or area or of its authorities,or concerning the delimitation of 
its frontiers or boundaries.Dotted lines on maps represent approximate border lines for which there
may not yet be full agreement.
The mention of specific companies or of certain manufacturers’products does not imply that they 
are endorsed or recommended by the World Health Organization in preference to others of a similar
nature that are not mentioned.Errors and omissions excepted,the names of proprietary products are
distinguished by initial capital letters.
The World Health Organization does not warrant that the information contained in this publication 
is complete and correct and shall not be liable for any damages incurred as a result of its use.
Printed in Switzerland.
All correspondence should be sent to the author.Eduardo Sabaté,World Health Organization,
avenue Appia 20,CH-1211 Geneva 27,Switzerland (sabatee@who.int).Requests for free electronic
copies (pdf format only) should be sent to:adherence@who.int
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C O N T E N T S
Preface
V
Ackowledgement
VII
Scientific writers
VIII
Introduction
XI
Take-home messages
XIII
Section I – Setting the scene
1
Chapter I – Defining adherence
3
Chapter II – The magnitude of the problem of poor adherence
7
Chapter III – How does poor adherence affect policy makers and health managers?
11
Section II – Improving adherence rates:guidance for countries
17
Chapter IV – Lessons learned
19
Chapter V – Towards the solution
27
Chapter VI –How can improved adherence be translated into health 
and economics benefits?
39
Section III – Disease-specific reviews
45
Chapter VII – Asthma
47
Chapter VIII – Cancer (palliative care)
59
Chapter IX – Depression
65
Chapter X – Diabetes
71
Chapter XI – Epilepsy
87
Chapter XII – HIV/AIDS
95
Chapter XIII – Hypertension
107
Chapter XIV – Tobacco smoking cessation
115
Chapter XV – Tuberculosis
123
Annexes
133
Annex I – Behavioural mechanisms explaining adherence
135
Annex II – Statements by stakeholders
151
Annex III – Table of reported factors by condition and dimension
162
Annex IV – Table of reported interventions by condition and dimension
166
Annex V – Global adherence interdisciplinary network (GAIN)
171
Where to find a copy of this book
177
Official designated depositories libraries for WHO publications
179
Reference libraries for WHO publications
183
WHO official sales agents world wide
195
Selected WHO publications of related interest
197
A ready-to-use pamphlet for partners willing to promote this book
199
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