Patient involvement most effective on compliance
Study shows phone, mail reminders not as effective
A study by researchers at the Ohio State University College of Medicine and Public Health in Columbus suggests that early telephone and postal reminders do not improve compliance with drug treatment or prompt patients to adopt risk-reducing behaviors. The study measured compliance with prescribed medication and lifestyle changes in 13,100 patients who were prescribed prevastatin to reduce their risk of a heart attack.
At the end of the study, there was no measurable difference in medication compliance between patients who received telephone and mailed reminders and those who did not, the researchers said. However, the researchers concluded, patients who reported taking the medication as prescribed also were more likely to make the recommended behavioral modifications, such as exercising, making dietary changes, and quitting smoking.
The study and other literature on the topic leads to the conclusion that efforts to enhance the physician-patient relationship and patient involvement in care are the most effective ways to improve medication compliance, says Robert Guthrie, MD, author of the study.1 "This study mounts a strong case that early telephone and postal reminders do not improve medication adherence or compliance with recommended risk-reducing behaviors. This result should be of particular interest to heath care providers, third-party payers, and health care policymakers," Guthrie says.
The nationwide study involved 13,100 primary care patients who were prescribed pravastatin therapy because they were at risk for a first myocardial infarction. An elevated total cholesterol level despite dietary interventions was one criterion for inclusion. Patients who agreed to participate were divided into two groups: Both groups were given a two-week supply of pravastatin at no charge, prescriptions for additional prevastatin, and recommendations about modifying lifestyle and complying with their medication regime from their physician.
The group that received the interventions received telephone reminders after two weeks and eight weeks, and reminder postcards at week four, reinforcing the message about coronary risk. The reminder cards stressed the importance of following physician instructions and taking medication as prescribed. Both groups received reminder postcards at four and five months and then filled out questionnaires about compliance at three months and six months. Questionnaires included information about use of prevastatin and lifestyle modifications, such as changing eating habits, losing weight, increasing physical activity, and quitting smoking.
Compliance also was assessed by the patients’ physicians. Of the 13,100 participants enrolled, 4,548 returned their six-month patient survey — 35% of patients in intervention group and 33% of those receiving usual care. After six months, 79.7% of patients receiving interventions reported taking their medication as prescribed, compared to 77.4% of patients who received the usual care. Approximately equal percentages reported that they had missed no doses in the previous seven days.
Baseline characteristics such as age, race, employment status, educational attainment, and comorbidity did not seem to be associated with self- reported compliance with prevastatin, Guthrie says. Medication adherence was associated with the adoption of other coronary risk-reducing behavior. Of those taking pravastatin as prescribed, 97.5% reported that they visited their physicians as scheduled, compared with 82% who were not compliant with prevastatin regimes. Better than 62% of the compliant group reported modifying their eating habits, compared with more than 51% in the noncompliant group.
Reference
1. Guthrie, R. The effects of postal and telephone reminders on compliance with pravastatin therapy in a national registry: Results of the rirst myocardial infarction risk reduction Program." Clinical Therapeutics, Vol. 23, No.2, pp 970-979.
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