Evidence-based interventions to improve patient compliance with antihypertensive and lipid-lowering medications.
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.
Petrilla
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AA
ValueMedics Research, LLC, 300 N. Washington Street, Suite 303, Falls Church, VA 22046, USA. allison.petrilla@valuemedics.com
Benner
J S
JS
Battleman
D S
DS
Tierce
J C
JC
Hazard
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EH
D000553:Ambulatory Care; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D019090:Case Management; D003376:Counseling; D004334:Drug Administration Schedule; D004349:Drug Packaging; D004359:Drug Therapy, Combination; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage*; D008499:Medical Records; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017010:Reminder Systems; D013689:Telephone
D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents