The treatment gap

There is evidence that there is a ‘treatment gap’ in the management of common chronic conditions – a gap between what we know should be practiced and what is being delivered by the existing health system.

There is a ‘treatment gap’ in the management of common chronic conditions such as cardiovascular disease and diabetes – a gap between what we know patients should be receiving, based on the national guidelines, and what they actually are receiving in the ‘real world’.

People with proven coronary disease have up to 7 times the chance of future coronary disease compared with people with similar risk factors but no overt coronary disease. There is unequivocal evidence that aggressive risk factor management improves patient survival, reduces recurrent events including premature cardiac death and improves quality of life for people with pre-existing cardiovascular disease.  Despite this, surveys from Australia and overseas repeatedly show that only a minority of people with cardiovascular disease are achieving the target levels for their disease risk factors to be able to prevent their disease from getting worse.

There are three possible reasons for this treatment gap:

1. Patients may not go to a doctor.
2. Patients may go to the doctor but may not adhere to the treatment recommended:
   1. • There is evidence that people who are prescribed self-administered medications typically take less than half the prescribed doses;
      • Even if patients are managed appropriately, many will discontinue their own treatment;
      • Adherence to lifestyle measures is poor.
3. Patients may go to the doctor but the doctors may not treat people according to the national clinical practice guidelines – they may not make the appropriate checks or tests, may not initiate treatment or titrate therapy to the dose required to achieve the target levels for their risk factors.

The COACH Program bridges the treatment gaps in the management of chronic diseases.