Effective drug treatments are available for many chronic conditions. But management of chronic diseases can be successful only if health professionals prescribe appropriately and if drugs are taken appropriately to maximise their pharmacological effects. A systematic review of interventions to improve adherence stated that, “ways to help people follow medical treatments could have far larger effects on health than any treatment itself.”1 Interventions to improve adherence in people with hypertension have targeted patients and health professionals, but studies in the past have often lacked methodological rigour.

Adherence to long term treatment for chronic illnesses in developed countries is about 50%, and rates are probably even lower in developing countries.2 In this week's BMJ, Qureshi and colleagues report the results of a cluster randomised controlled trial of a simple educational package delivered to 78 general practitioners in Karachi, Pakistan.3 The intervention consisted of …