A ‘synthetic indicator of adherence’ integrated into the new system of guarantee of essential levels of assistance (Lea) to measure therapeutic adherence in chronic diseases in a standardized way at national level: is the proposal formulated by ‘Long-lived Italy‘, the national association for aging and active longevity of the Ministry of Health, to give a concrete answer to the problem of poor adherence to care, particularly relevant among the elderly and strongly exacerbated by the pandemic.
With over 8 million over 65s suffering from at least one chronic disease, 5 and a half million having at least three and about 2 million elderly people forced to take at least 10 drugs a day – reads a note – adherence to care is a key factor in ensuring an active and healthy old age (chronic diseases are responsible for 80% of the years with disabilities and over 70% of deaths worldwide) and, at the same time, the maintenance of the NHS. Taking into consideration some of the most common cardiovascular diseases, adherence levels of at least 80% would allow for a total annual saving of 522 million euros for dyslipidemias and 898 million euros for hypertension.
To make these data known, underlining the urgency of making adherence a strategic public health objective, starting with the definition of an indicator that standardizes its measurement through virtuous benchmarking between the Regions, is the Expert Opinion Paper “”Adherence to long-term care governance: proposal for a synthetic indicator”, Promoted by ‘Italia Longeva’ and shared with the Directorate General of Health Planning of the Ministry of Health. The Paper was presented today during the event “Measuring adherence in long-term care governance: key players in comparison”, in the presence of decision-makers and key players in the health system at central and regional level.
“Adherence to drug treatment must be considered an essential parameter to ensure the health of the population, in particular of the elderly, and to make our health system more efficient “, says the geriatrician Roberto Bernabei, president of Italia Longeva. “It is a topic that has been talked about for years but, to date – he points out – there is no valid evaluation tool for all pathologies and easily implemented from Valle d’Aosta to Sicily. The real step forward is the proposal of a synthetic indicator as a standardized strategy for measuring adherence throughout the country, able to give us a snapshot of the quality of health care and to correct the shot where necessary “.
“Therapeutic adherence, especially in the area of chronicity, is certainly an issue worthy of attention and could be verified as part of the revision of the indicators of the New Guarantee System, in a process shared with the Regions “, explains Andrea Urbani, Director General of Health Planning of the Ministry of Health.
With the Italia Longeva Paper, a systematic review of the literature of the last 10 years was carried out, aimed at identifying and evaluating the indicators of adherence to therapies for chronic diseases in the Italian population. Furthermore, the available evidence on the costs associated with non-adherence and on the effectiveness of actions aimed at reducing it were analyzed, with a view to estimating the potential savings for the NHS. “A sub-optimal use of therapies represents one of the major parameters of inefficiency of the NHS“he explains Federico Spandonaro, president of Crea Sanità, University of Rome Tor Vergata.
“An increase in adherence, although it does lead to an increase in pharmaceutical costs – continues Spandonaro – determines a more than proportional reduction in total direct healthcare costs, mainly due to the reduction in medical visits and hospital admissions. The study shows that if levels of adherence to therapies greater than 80% were reached, there would be a median annual per capita saving of 462 euros for hypertension, 659 euros for dyslipidemias and 572 euros for heart failure. “.
Among the various actions implemented to improve adherence, those that have proved to be the most cost-effective and therefore able to significantly affect the reduction of healthcare costs – the note continues – are represented by ieducational interventions aimed at patients and healthcare personnel, l’use of drugs in fixed combination or of poly-pills that allow to simplify the therapy, the involvement of pharmacies and health personnel, the reduction of out-of-pocket spending (entirely borne by the citizen) and monitoring adherence through ad hoc interventions.
“The issue of adherence is absent from the current 88 criteria to be respected to guarantee the fulfillment of the Lea – concludes Bernabei – and therefore to ensure the appropriateness and equity of care for citizens. A guarantee that, once a standard level of compliance has been established, it could prove to be a powerful incentive mechanism for the Regions to invest in concrete actions to increase the levels of adherence and improve the health of their citizens ”.