The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review

Abstract

Summary Objectives: To review studies of patient compliance/persistence with cardiovascular or antidiabetic medication published since the year 2000; to compare the methods used to measure compliance/persistence across studies; to compare reported compliance/persistence rates across therapeutic classes and to assess whether compliance/persistence correlates with clinical outcomes. Methods: English language papers published between January 2000 and November 2005 investigating patient compliance/persistence with cardiovascular or antidiabetic medication were identified through searches of the MEDLINE and EMBASE databases. Definitions and measurements of compliance/persistence were compared across therapeutic areas using contingency tables. Results: Of the 139 studies analysed, 32% focused on hypertension, 27% on diabetes and 13% on dyslipidaemia. The remainder covered coronary heart disease and cardiovascular disease (CVD) in general. The most frequently reported measure of compliance was the 12‐month medication possession ratio (MPR). The overall mean MPR was 72%, and the MPR did not differ significantly between treatment classes (range: 67–76%). The average proportion of patients with an MPR of > 80% was 59% overall, 64% for antihypertensives, 58% for oral antidiabetics, 51% for lipid‐lowering agents and 69% in studies of multiple treatments, again with no significant difference between treatment classes. The average 12‐month persistence rate was 63% and was similar across therapeutic classes. Good compliance had a positive effect on outcome in 73% of the studies examining clinical outcomes. Conclusions: Non‐compliance with cardiovascular and antidiabetic medication is a significant problem, with around 30% of days ‘on therapy’ not covered by medication and only 59% of patients taking medication for more than 80% of their days ‘on therapy’ in a year. Good compliance has a positive effect on clinical outcome, suggesting that the management of CVD may be improved by improving patient compliance.

Self-report measures of medication adherence behavior: recommendations on optimal use

“…IMPACT OF MEDICATION ADHERENCE Across many chronic medical conditions, adherence has been associated with positive clinical outcomes including improved disease control, reduced symptoms, and decreased complications, hospitalization, and mortality [13][14][15][16][17][18][19][20]. Even modest nonadherence (e.g., 10-20 %) has been linked with clinically significant deteriorations in health outcomes, such as glycemic control, low-density lipoprotein cholesterol levels, and risk for coronary disease [21,22], as well as failure to achieve health improvements [23], leading to higher healthcare costs [21,24].…”

“…Other large studies crossing multiple chronic conditions and drug classes report nonadherence rates around 40-60 % [25, 28, 29], suggesting that approximately one of every two prescription doses are missed. Medication adherence tends to decline over time [30,31] and discontinuation (nonpersistence) is common [13]. …”

Persistence of oral antidiabetic treatment for type 2 diabetes characterized by drug class, patient characteristics and severity of renal impairment: A Japanese database analysis

“…According to the World Health Organization, non‐adherence to long‐term medications for diseases such as hypertension, dyslipidaemia and diabetes is common, leading to compromised clinical outcomes and major economic consequences 9. Patients' likelihood of maintaining adherence to and persistence with treatment is important, therefore, when choosing from a complex array of OADs 8, 9, 10, 11. According to a literature review of six retrospective observational studies from the United States, Canada and Europe between January 2000 and November 2005, the mean estimated OAD persistence over 6 to 24 months was 56% (95% confidence interval [CI] 46‐66), with estimates ranging from 41% to 81% 12.…”

Translational Behavioral Medicine: a pathway to better health

“…We know that people get sicker or fail to recover because they don't adhere to treatments. In fact, only about 50% of prescribed medications are actually taken [8,9]. And yet, few countries spend very much money to address behavioral or psychosocial influences on health.…”