Evidence-based interventions to improve patient compliance with antihypertensive and lipid-lowering medications

Abstract

The MEDLINE database was searched from 1972 to June 2002 to identify studies of interventions designed to improve compliance with antihypertensive or lipid-lowering medications. Studies were required to employ a controlled design, follow patients for >or=6 months and measure compliance by a method other than patient self-report. The literature review yielded 62 studies describing 79 interventions. Overall, 56% of interventions were reported to improve patient compliance. When only those studies meeting minimum criteria for methodological quality were considered, 22 interventions remained and 12 were recommended, because they demonstrated a significant improvement in compliance. Recommended interventions included fixed-dose combination drugs, once-daily or once-weekly dosing schedules, unit-dose packaging, educational counselling by telephone, case management by pharmacists, treatment in pharmacist- or nurse-operated disease management clinics, mailed refill reminders, self-monitoring, dose-tailoring, rewards and various combination strategies. Personalised, patient-focused programs that involved frequent contact with health professionals or a combination of interventions were the most effective at improving compliance. Less-intensive strategies, such as prescribing products that simplify the medication regimen or sending refill reminders, achieved smaller improvements in compliance but may be cost-effective due to their low cost.

Metabolic effects of interventions to increase exercise in adults with type 2 diabetes

“…Self-monitoring (recording exercise behaviour) is often suggested as a way to improve chronic illness selfmanagement behaviours [30][31][32][33]. The presence of exercise self-monitoring was associated with lower ESs in this metaanalysis.…”

Medication Adherence

“…In general, unimodal interventions have been less successful than multimodal interventions, because the reasons for nonadherence are often multifactorial. [67][68][69][70][71][72] Unimodal interventions that have demonstrated some success include those that reduced the number of daily doses of medications, used motivational strategies, packaged medications into special containers (eg, pill boxes or blister packs), provided more convenient care, educated patients, or involved monitoring and feedback. For example, Smith et al 73 recently published findings of a cluster randomized trial in 4 geographically dispersed health maintenance organizations that sent informational mailings on ␤-blocker therapy to patients recently discharged for acute myocardial infarction and prescribed ␤-blockers.…”

Challenges for Improving Medication Adherence

“…Attempts are often made to simplify the patient's drug regimen by reducing the number of pills consumed per day and by reducing medication costs. [7][8][9] Pharmacists are often involved in assessing adherence and offering advice to physicians about simplifying and improving drug regimens.12-16 Direct counseling of patients by pharmacists may be particularly promising because of pharmacists' specialized training and knowledge of medications and availability to patients.In this issue of JAMA, Lee and colleagues 17 report the results of a pharmacy care program designed to improve medication adherence for patients with multiple chronic medical conditions, including hypertension and elevated cholesterol levels. The study focused on elderly patients who were taking multiple medications and therefore were at risk for poor adherence.…”