No Simple Way to Help Patients Stick to Their Meds
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By Charnicia E. Huggins

NEW YORK (Reuters Health) - Giving patients simple, clear instructions about how to take their medications may make them more likely to comply with a short-term treatment regimen, but it does little to make them adhere to long-term treatments, study findings show.



Helping patients stick to their life-long prescription regimens for high blood pressure, asthma and other chronic conditions may require a more complex system involving combinations of oral and written instructions, counseling, family involvement and patient reminders, according to a team of Canadian researchers.


Previous study findings indicate that many patients do not completely adhere to their medication prescriptions. In some cases, patients may stop taking their medication prematurely, and in others they may simply forget to take all of the medication at the appropriate times, both of which can undermine the benefits of their therapy.


"For most treatments, we don't get as much goodness out of them as there are in them because people simply don't follow the treatment," study author Dr. R. Brian Haynes from the McMaster University Faculty of Health Sciences in Ontario told Reuters Health.


He and his colleagues reviewed 33 studies of 39 different simple and complex interventions designed to help patients adhere to their treatment regimens.


Overall, almost half of the interventions, used in studies of patients with high blood pressure, asthma, schizophrenia and various other conditions, helped patients do a better job of sticking to their medication regimens, the investigators report in the December 11th issue of The Journal of the American Medical Association (news - web sites).


Studies that measured patient adherence to short-term regimens, such as a 10-day antibiotic treatment, found that counseling and written instructions were enough to encourage patients' full compliance with their prescriptions.


For long-term regimens, multifaceted interventions were most effective, the report indicates, but even those were not associated with great improvements in patient compliance or with better treatment outcomes, such as more blood pressure control for patients with hypertension.


In fact, only 17 studies found that the interventions used were associated with improvements in treatment outcome, the researchers note.


"Sometimes the regimens people are prescribed are way too complicated," Haynes said. "Most people are on automatic pilot in the morning; if they don't lay out their medications in an organized fashion they are very prone to forgetting them."


Therefore, to maximize benefit from prescription medications, patients should use pill organizers, if needed, and should also agitate to have complicated regimens simplified in some way, he added.

For example, people who are instructed to take a particular medication at noon, which may often be an inconvenient time of day, should ask their doctors if they could take it at a different time. Also, patients who are on multiple medications should ask their doctors if the pills can be taken together, rather than assuming they must be spread out during the day, Haynes advised.

The study was led by Heather P. McDonald of McMaster University School of Graduate Studies in Ontario.

SOURCE: The Journal of the American Medical Association 2002;288:2868-2879.