The alarming increase in chronic conditions has the world’s healthcare authorities worried. Diabetes, cancer, chronic respiratory disease, hyperlipaedemia (high cholesterol), hypertension, strokes and heart disease are all on the rise. In fact, they are the leading cause of mortality in the world, representing 60% of all deaths.
Sadly, the increase is driven largely by poor lifestyle choices, little exercise, too much processed foods and smoking.
In the United States about half the adult population — approximately 130-million people — are suffering from a chronic condition. And when you examine recent research on these lifestyle diseases, South Africa is hardly lagging behind.
We’re well placed to overtake the US as the world’s most obese nation. Almost 50% of our population is overweight or obese. Which means half our population is running a real risk of contracting one or more of these chronic conditions.
Fortunately, in the past few years major strides in research and development by the pharmaceutical industry has led to new-generation drugs and new categories of drugs that are more successful in controlling chronic conditions. Also, effective managed-care programmes have been developed that, in combination with the right medication and supervision, go a long way to ensure that chronic patients can still live relatively normal lives.
However, there is a major stumbling block: non-adherence with the prescribed drugs or people not taking their pills as they should. Research conducted in 2007 by Mediscor, a Gauteng-based managed healthcare company, revealed that as many as 50% of South Africans with chronic conditions are non-adherent.
The reasons for this: US research surveys point to plain forgetfulness in 25% of cases, with a lack of knowledge about the condition or the drug accounting for 15%, side effects of the medication are cited for another 21%, the cost of the drugs is blamed by 18% of patients, with 21% of patients stating other reasons.
The problem is exacerbated by the fact that most of these conditions are free of symptoms in the early stages, a situation that leads to a false sense of security: “I feel fine, so what’s the big deal if I don’t take my drugs?”
The big deal for people with hypertension who do not take their medication, for example, is the risk of having a stroke and experiencing heart failure in the long run. Patients who battle to control their cholesterol levels are at risk of cardiovascular and peripheral vascular disease.
The big deal for patients with type-2 diabetes is a real risk of heart attack, blindness, amputation of limbs, kidney disease and problems with the nervous and circulatory systems.
Add up these risks and you have a recipe for disaster. For patients with conditions such as HIV/Aids, just missing one daily dose of antiretrovirals can lead to serious ramifications as the virus will attack the patient’s immune system.
It’s well documented that it was the failure of some TB patients to take their drugs for the duration of the prescribed course that led to the TB bacteria mutating into deadly strains of multi-drug-resistant TB.
Besides the heavy toll on patients, it puts a major strain on healthcare resources, costing billions of rands. For example, it’s estimated that non-adherence represents 69% of all hospital admissions and 55% of emergency-room visits. Non-adherence to chronic medication is a major problem, not just in South Africa, but also around the world. It’s an issue that requires innovative and creative solutions.
Chronic medication will be the topic of Bonitas Housecall on Saturday 9 April at 9am on SABC2