Active Citizenship Network, the European branch of the Italian NGO Cittadinanzattiva, promotes the European Patients’ Rights Day as multi-stakeholder event since 2007, and as its Director, I am so honored to celebrate this relevant anniversary at the EU Parliament.

In line with the topic of healthcare systems’ sustainability, addressed in the previous conferences of the European Patients‘ Rights Day, the twelfth edition has  contributed to the current policy debate on how to achieve a more sustainable provision of care.

As underlined by the Health Commissioner in his video message, the poor adherence to treatments has significant implications as we refer to human lifes before considering costs: It is estimated that each year the poor adherence to medical treatments in Europe causes about 200,000 deaths and burdens on health expenditure up to 80 billion euro a year.

Improving treatments and reducing costs, thanks to an enhanced treatment adherence are our main challenges; our duty, especially for what concerns the chronicity.

From our point of view, the topic is linked to several patients' rights stated in the European Charter of Patients Rights: the right to information, the right to preventive measures, the right to consent and the right to personalized treatment. The "European Charter on Adherence to Therapy" summarize all these rights making explicit that adherence to treatment is a right of the chronic patient.

We are aware that monitoring the compliance implies the patient as a whole: adherence to therapies, adherence to healthy lifestyles, adherence to national prevention programmes and to screenings.

Patients do not always adhere to therapy,  and the causes of lack or little adherence to treatments are different, but can be divided in intentional and unintentional. We need to act on both sides: this topic hides an huge problem of awareness.

Patient’s awarness: patient has to understand why he needs treatments.

Medical Doctor’s awareness: he has to adapt therapy according to the specific characteristics of each patients.

Therapeutic adherence is possible when patient has accepted the disease and the problems related to the proposed therapy, when he takes part actively to the therapeutic plan, when there is a consolidates trust between Medical Doctor and patient.

All the above said is worthless if there is not a proper prescription. Proper prescription fulfill a main role to avoid the rise of negative events dued to therapeutic choices not properly targeted.

Polypharmacy is common in older people, as they typically show multimorbidity. Polypharmacy and multimorbidity also raise challenges regarding adherence.

There is a clinical paradigm according to more medications are prescribed, bigger is the chance of not compliance.

Italian Medicine Agency released significant figures about proper prescription. In Italy an average of 50% do not adhere to therapy, an elder over 65, every 2 take more than 5 medicines per day; almost 60% of them do not adhere properly to therapies against depression, hypertension, diabetes and osteoporosis.

In Europe the data are not so different; in fact, 40% of people aged 65 and over consume between five and nine medicines per week; this number is even higher for 18% of this population where the consumption rate can be of more than 10 medicines weekly.

According the “Action Group on Prescription and adherence to medical plans” promoted by EU Commission: 79% of patients take their “once  a day” dose, but only 51% of those supposed to take four doses, do so. Among patients with  chronic illness, approximately 50% do not take medications as prescribed. In addition to polypharmacy, attention must be also paid to the appropriateness of  the prescribing, as studies have found that between 55 and 59% of the medicines used by the older people are prescribed without indication or with a less than optimal indication.

It is important that patients or those who take care of them are adequately informed about the importance of adherence to treatment and the risks of non-adherence. This role requires coordination between general practitioners, pharmacists, patient organizations and the entire health system. Because barriers to medication adherence  are  complex  and  varied, solutions to improve adherence must be multifactorial and multistakeholder.

For sure, the drug manufacturing companies have to develop more and more appropriate therapeutic solutions, simplifying treatments, favoring pro-memory packaging and other solutions that can facilitate the appropriate use of drugs by patients. Last but not least, reducing prize. In this context, no one can be excluded.

Mariano Votta
Director Active Citizenship Network


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