Feeling better, forgetting, fear of adverse drug reactions, taking multiple medicines several times a day, or burdensome financial costs of treatment are the main reasons for the low adherence, i.e. non-compliance of patients with the treatment regimen. This is a significant health problem, leading to a deterioration in health, an increase in hospitality rates, higher healthcare costs and, ultimately, unnecessary deaths. Studies show that good adherence can reduce mortality risk by up to 21%. The problem applies to all patients, but the significant effects of low adherence are especially for patients with cardiovascular diseases. About 25 000 people die from cardiovascular diseases in Slovakia every year, which exceeds the combination of death of accidents and cancer.


March 27 is historically the first time declared World Adherence Day. Its aim is to draw attention to compliance with treatment. Slovakia is also added to the global initiative of professional medical companies and patient associations in order to motivate patients to a responsible approach to treatment and hence to their own health. –Adherence to treatment is not only a medical problem, but also a societal challenge. We have effective medicines, we have experts, but if the patient fails to comply with the treatment, we are losing much of their benefit. The Ministry of Health is aware that without a systematic approach to promoting adherence, we cannot effectively improve the health status of the population. Slovakia is adding to this day's global efforts to improve patients' health literacy and access to their own health;Ing. Michal Štofko, PhD., State Secretary MZ SR.


Patients interrupt treatment because they feel wellAdherence is compliance with the treatment regimen, including correct use of medications, medical advice, regimen measures such as diet, exercise and regular medical check-ups. It ensures the effectiveness of treatment, leads to better control of chronic diseases, less symptoms and less risk of complications. According to a survey conducted in 130 Slovak clinics of general practitioners involving 727 patients, only 40% of patients comply with all regimen measures recommended by the physician and 61 percent take prescription medications. As a practical doctor, I see patients who interrupt treatment every day because they feel better in time. And then they come back with avoidable complications. Our job is not only to prescribe drugs but also to explain why it is important to take them regularly. Even a small change in access to treatment can have a major impact on the patient's health, explains MUDr. Etela Janeková, PhD., head expert of MZ SR for general medicine.
The mission of the General Health Insurance Agency, as the largest health insurance company in Slovakia, is to provide almost 3 million insured persons with the best possible health care. One of the conditions for the success of healthcare provision is cooperation and the patient's willingness to accept the doctor's recommendations. A lack of willingness or inability to cooperate is an essential factor, affecting both the effectiveness of treatment and the cost of healthcare. The situation is exacerbated by a lack of perception of the risks of untreated diseases as well as limited access to positive information on the long-term benefits of treatment. It is true that an educated patient understands the ability to influence his or her health by his or her own activity. Cost-effectiveness is also a major argument. For example, when a patient with high blood pressure or diabetes takes medicines regularly as recommended by a doctor, it reduces the risk of unwanted complications, the treatment of which requires incomparably more resources from public insurance. However, non-nadherency may not be limited to the patient. It can be applied to doctors in direct connection with compliance with the principles of healthcare provision according to expert advice. We see the importance in the approach taken by health insurance companies in communicating with the insured person, as well as in making use of the contribution possibilities, says director of the Health Activities Section of General Health Insurance, Lucia Vitárius.


Untreated high blood pressure leads to heart attacks or vascular eventsCardiovascular diseases are the result of unhealthy lifestyles such as inappropriate diets, smoking, any consumption of alcohol, or lack of exercise, chronic and toxic stress, untreated traumas as well as associated diseases, social, environmental and genetic factors. The common denominator is the lack of interest, the absence of a sense of responsibility for your health and, in most patients, ignorance. According to a survey of general doctors' offices in Slovakia, one in five patients who came to check their doctor and had not been treated for high pressure until now did not know that he was elevated. High blood pressure is the leading cause of premature and avoidable deaths worldwide. – Adherence to treatment is a key factor in the prevention and treatment of chronic diseases, both transferable and non-transferable. WHO has for years pointed out that lack of adherence is one of the causes of premature deaths from diseases that would otherwise be treatable. In Slovakia, 40% of deaths account for treatable diseases, says Prof. MUDr. Jozef Šuvada, PhD., representative of the Slovak Republic in the World Health Organization (WHO).


The aim of the treatment of hypertension is not only to lower the pressure as such, but especially to protect the health of the heart and blood vessels. –Untreated high blood pressure can lead to serious complications such as heart attack, stroke, kidney damage, or vision. Treatment is not only about numbers on the pressure gauge, but about protecting the heart and blood vessels to prevent fatal consequences. Cardiovascular diseases are the long-term most common cause of death in 2021 for 36% of all deaths in Slovakia. Monika Kulinová, President of the Slovak Hypertension Society. Well-treated patients can achieve a quality of life comparable to healthy people without high blood pressure. In Slovakia, modern medicines are available to treat hypertension. However, we do not all exploit their full potential. According to European guidelines (ESC/ ESH), we can treat up to 90% of hypertensives with one tablet daily, which would help significantly improve patients' adherence to treatment and fulfil the vision of Charter 70/2028; MUDr. Monika Kulinová stressed.


Adherence affects treatment success and patient healthChronic venous disease (DVD), most commonly in clinical practice the disease of the veins of the legs, is a long-term, inflammatory and progressive disease that requires regular and long-term treatment, including compression therapy, use of venopharmaceuticals, lifestyle changes and regular exercise. "One of the biggest challenges is to convince patients that compliance with treatment is important even when they feel well. However, the reason for low adherence is also underestimating the severity of the disease, incorrect choice and consequently discomfort in wearing compression stockings, but also the cost of treatment. On the other hand, even chronic venous disease can now be kept under control and prevent potential risks, but without the patient's cooperation it can not be done," says doc. MUDr. Denisa Čelovská, PhD., president of Slovak angiology company, I. internal clinic LF UK and UNB Bratislava. Non-adherence may contribute to the development of varixes, a venous ulcer of the forehead and increase the risk of complications such as venous thrombosis, but also pulmonary embolism.
Oncological therapy, including chemotherapy, immunotherapy, targeted medications and radiotherapy, requires a strictly observed treatment regimen to achieve maximum efficacy. Low adherence to treatment may lead to failure of therapy, relapse of disease and a worse patient prognosis. The treatment of cancer patients is crucial, but not always easy. The side effects of treatment, the psychological burden, the complexity of the treatment regimen and the need for communication with several specialists affect the patient's willingness to follow the treatment. Support for families, experts and patient organisations is very important for cancer patients. It is not a shame to look for psychological or psychiatric assistance when dealing with stress and anxiety from demanding treatment, and to close Ladislav Doctor, Chairman of Lymphoma and Leukemia Slovakia.
Key factors to support patient adherenceSupporting patients' adherence to treatment is crucial. To keep patients motivated to follow the treatment regimen, it is important to start with practical steps to help them integrate treatment into daily life. Use reminders such as setting your alarm on your phone, using a calendar or apps to remind you about medicines. Combining medication with daily habits such as breakfast or tooth cleaning facilitates regularity and reduces the risk of missed doses. In patient organizations, we encounter stories of people who, only in serious health complications, realize that they could do more for their health. For each patient, it is important to understand the nature of the disease and treatment, to be motivated by family, friends or patient associations and, last but not least, not to be afraid to ask the doctor if I do not understand something," says Ing. Peter Kollárik, President A union for a healthier heart.