The clinical investigator

, Volume 70, Issue 2, pp 163–166 | Cite as

Patient compliance with drug treatment — new perspectives on an old problem

  • W. Kruse
Clinical Pharmacology

Summary

Compared to other variables being considered in therapeutics, patient compliance has long been given minor attention although it affects every aspect of medical care. Limited methodology of compliance measurement, in particular, has hampered major progress in research, and pre-conceptions have been reiterated. However, there is a recent surge in interest derived from new data revealed by reliable methods, i.g. continuous medication (compliance) monitoring. The visualization of dynamics in drug regimen compliance over time offers unique opportunities, both to scientific drug evaluation and therapeutics in medical practice. New perspectives related to the descriptive and explanatory side of the problem are outlined by giving examples from various therapeutic fields.

Key words

Patient compliance Compliance monitoring Drug evaluation 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Anon (1991) Patient compliance in therapeutic trials. Lancet 337:823–824Google Scholar
  2. 2.
    Anon (1991) Helping patients to make the best use of medicines. Drug Ther Bull 29:1–2Google Scholar
  3. 3.
    Heilmann K, Herrmann M (1990) Patient and Arzneimittel. Arbeitsgemeinschaft Gesundheit und Gesellschaft des Institutes für Untersuchung technologischer and wirtschaftlicher Entwicklungen im Gesundheitswesen und der Infratest Gesundheitsforschung. MünchenGoogle Scholar
  4. 4.
    Benet LZ (1990) Principles of prescription order writing and patient compliance instructions. In: Goodman Gilman A, Rall TW, Nies AS, Taylor P (eds) The pharmacological basis of therapeutics 8. Pergamon Press, Oxford New York, pp 1640–1649Google Scholar
  5. 5.
    Black DM, Brand RJ, Greenlick M, Hughes G, Smith J (1987) Compliance to treatment for hypertension in elderly patients: the SHEP Pilot Study. J Geront 42:552–557Google Scholar
  6. 6.
    Center for the Study of Drug Development. Tufts University (1989) Proceedings of the symposium on compliance monitoring. Woodbridge, NJGoogle Scholar
  7. 7.
    Cheung R, Sullens CM, Seal D, Dickins J, Nicholson PW, Deshmukh AA, Denham MJ, Dobbs SM (1988) The paradox of using a 7 day antibacterial course to treat urinary tract infections in the community. Br J Clin Pharmac 26:391–398Google Scholar
  8. 8.
    Coats AJS, Adamopoulos S, Meyer TE, Conway J, Sleight P (1990) Effects of physical training in chronic heart failure. Lancet 335:63–66Google Scholar
  9. 9.
    Cramer JA (1991) Identifying and improving compliance patterns: a composite plan for health care providers. In: Cramer JA, Spilker B (eds) Patient compliance in medical practice and clinical trials. Raven Press, New York, pp 387–392Google Scholar
  10. 10.
    Cramer JA, Spilker B (eds) (1991) Patient compliance in medical practice and clinical trials. Raven Press, New YorkGoogle Scholar
  11. 11.
    Cramer JA, Collins JF, Mattson RH (1988) Can categorization of patient background problems be used to determine early termination in a clinical trial? Contr Clin Trials 9:47–63Google Scholar
  12. 12.
    Cramer JA, Mattson RH, Prevey ML, Scheyer RD, Quellette VL (1989) How often is medication taken as prescribed? A novel assessment technique. JAMA 261:3273–3277Google Scholar
  13. 13.
    Cramer JA, Scheyer RD, Mattson RH (1990) Compliance declines between clinical visits. Arch Intern Med 150:1509–1510Google Scholar
  14. 14.
    Drug Information Association (1989) The impact of partial compliance in clinical trials. PhiladelphiaGoogle Scholar
  15. 15.
    Efron B, Feldman D (1991) Compliance as an explanatory variable in clinical trials. J Am Stat Assoc 86:9–26Google Scholar
  16. 16.
    Engström F (1991) Clinical correlates of antidepressant compliance. In: Cramer JA, Spilker B (eds) Patient compliance in medical practice and clinical trials. Raven Press, New York, pp 187–194Google Scholar
  17. 17.
    Feinstein AR (1990) On white-coat effects and the electronic monitoring of compliance. Arch Int Med 150:1377–1378Google Scholar
  18. 18.
    Schmidt D, Leppik (1988) Compliance in epilepsy. Epilepsy Res [Suppl 1] Elsevier, Amsterdam New York OxfordGoogle Scholar
  19. 19.
    Proceedings of the first international symposium on compliance monitoring (1988) HeidelbergGoogle Scholar
  20. 20.
    Fischer B, Lehrl U, Fischer U, Weber E (1983) Drug compliance of progeriatric rehabilitation patients. Brief communication on a longitudinal investigation. Akt Gerontol 13:101–103Google Scholar
  21. 21.
    Goldsmith CH (1979) The effect of compliance distributions on therapeutic trials. In: Haynes RB, Taylor DW, Sackett DL (eds) Compliance in health care. The Johns Hopkins University Press, Baltimore London, pp 297–308Google Scholar
  22. 22.
    Gordis L (1979) Conceptual and methodologic problems in measuring patient compliance. In: Haynes RB, Taylor DW, Sackett DL (eds) Compliance in health care. The Johns Hopkins University Press, Baltimore London, pp 23–45Google Scholar
  23. 23.
    Gundert-Remy U, Möntmann U, Weber E (1978) Studien zur Regelmäßigkeit der Einnahme der verordneten Medikamente bei stationären Patienten. Inn Med 5:78–83Google Scholar
  24. 24.
    Harter JG, Peck CC (1991) Chronobiology: suggestions for integrating it into drug development. Ann NY Acad Sci 618:563–571Google Scholar
  25. 25.
    Hasford J (1991) Biometric issues in measuring and analyzing partial compliance in clinical trials. In: Cramer JA, Spilker B (eds) Patient compliance in medical practice and clinical trials. Raven Press, New York, pp 265–281Google Scholar
  26. 26.
    Haynes RB (1979) Introduction. In: Haynes RB, Taylor DW, Sackett DL (eds) Compliance in health care. The Johns Hopkins University Press, Baltimore London, pp 1–7Google Scholar
  27. 27.
    Haynes RB, Wang E, Da Mota Gomes M (1987) A critical review of interventions to improve compliance with prescribed medications. Pat Educ Counsel 10:155–166Google Scholar
  28. 28.
    Inui TS, Yourtee EL, Williamson JW (1976) Improved outcomes in hypertension after physician tutorials. A controlled trial. Ann Intern Med 84:646–651Google Scholar
  29. 29.
    Johnson BF, Whelton A, Mc Mahon FG (1991) Betaxolol versus atenolol in hypertension: a comparison of efficacy, duration of response, and effects of withdrawal. Am J Hypertens 3/II:121 AGoogle Scholar
  30. 30.
    Joyce CRB (1962) Patient co-operation and the sensitivity of clinical trials. J Chron Dis 15:1025–1036Google Scholar
  31. 31.
    Kass MA, Meltzer DW, Gordon M, Cooper D, Goldberg J (1986) Compliance with topical pilocarpine treatment. Am J Ophthalmol 101:515–523Google Scholar
  32. 32.
    Kruse W (1991a) Compliance with treatment of hyperlipoproteinernia in medical practice and clinical trials. In: Cramer JA, Spilker B (eds) Patient compliance in medical practice and clinical trials. Raven Press, New York, pp 175–186Google Scholar
  33. 33.
    Kruse W (1991b) Early readmission of elderly patients with congestive heart failure. J Am Geriatr Soc (in press)Google Scholar
  34. 34.
    Kruse W, Weber E (1990) Dynamics of drug regimen compliance — its assessment of microprocessor-based monitoring. Eur J Clin Pharmacol 38:561–565Google Scholar
  35. 35.
    Kruse W, Schlierf G, Weber E (1989) Dynamically compliance monitoring — its utility for the interpretation of drug trials. Eur J Clin Pharmacol 36 [Suppl A]:289Google Scholar
  36. 36.
    Kruse W, Schlierf G, Weber E (1990) Monitoring compliance in clinical trials. Lancet 335:803–804Google Scholar
  37. 37.
    Kruse W, Eggert-Kruse W, Rampmaier J, Runnebaum B, Weber E (1991) Dosage frequency and patients' drug-compliance behaviour — a comparative study on compliance with a medication to be taken twice or four times daily. Eur J Clin Pharmacol (in press)Google Scholar
  38. 38.
    Kruse W, Koch-Gwinner P, Nikolaus T, Oster P, Schlierf G (1991) Drug compliance behavior in geriatric patients after discharge from hospital. J Am Geriatr Soc (in press)Google Scholar
  39. 39.
    Lasagna L (1989) Pharmacometry in man: the state of the art. In: Lasagna L, Erill S, Naranjo CA (eds) Dose-response relationships in clinical pharmacology. Excerpta Medica, Amsterdam, pp 1–7Google Scholar
  40. 40.
    Lipid Research Clinics Program (1984) The Lipid Research Clinics Coronary Primary Prevention Trial results: II. The relationship of reduction in incidence of coronary heart disease and cholesterol lowering. JAMA 251:365–374Google Scholar
  41. 41.
    Mäenpää H, Manninen V, Heinonen OP (1987) Comparison of the digoxin marker with capsule counting and compliance questionnaire methods for measuring compliance to medication in a clinical trial. Eur Heart J 8 [Suppl 1]:39–43Google Scholar
  42. 42.
    Meichenbaum D, Turk DC (1987) Facilitating treatment adherence. Plenum Press, New YorkGoogle Scholar
  43. 43.
    Moulding T (1979) The unrealized potential of the medication monitor. Clin Pharmacol Ther 25:131–136Google Scholar
  44. 44.
    Mushlin AI, Appel FA (1977) Diagnosing potential noncompliance: physicians' ability in a behavioral dimension of medical care. Arch Intern Med 150:318–321Google Scholar
  45. 45.
    Norell SE (1981) Accuracy of patient interviews and estimates by clinical staff in determining medication compliance. Sec Sci Med 15 E:57–61Google Scholar
  46. 46.
    Norell SE (1983) Methods in assessing drug compliance. Acta Med Scand 213 [Suppl 683]:35–40Google Scholar
  47. 47.
    Norell SE, Granström P-A (1980) A medication monitor and fluorescein technique designed to study medication behaviour. Acta Ophthalmol 58:459–467Google Scholar
  48. 48.
    Pullar T, Kumar S, Tindall H, Feely M (1989) Time to stop counting the tablets? Clin Pharmacol Ther 46:163–168Google Scholar
  49. 49.
    Rudd P (1979) In search of the gold standard for compliance measurement. Arch Intern Med 139:627–628Google Scholar
  50. 50.
    Rudd P, Byyny RL, Zachary V, Lo Verde ME, Titus C, Mitchell WD (1989) The natural history of medication compliance in a drug trial: limitations of pill counts. Clin Pharmacol Ther 46:169–176Google Scholar
  51. 51.
    Rudd P, Ahmed S, Zachary V, Barton C, Bonduelle D (1990) Improved compliance measures: applications in an ambulatory hypertensive drug trial. Clin Pharmacol Ther 48:676–685Google Scholar
  52. 52.
    Schweizerische Gesellschaft für Pharmakologie und Toxikologie, Sektion Klinische Pharmakologie (1989) Variability in drug response: the problem of compliance. BaselGoogle Scholar
  53. 53.
    University of Leeds, Dept. of Clinical Pharmacology (1991) Workshop methods of measuring compliance: ‘Horses for courses?’ Symposium on compliance with drug therapy. LeedsGoogle Scholar
  54. 54.
    Urquhart J (1991) Patient compliance as an explanatory variable in four selected cardiovascular studies. In: Cramer JA, Spilker B (eds) Patient compliance in medical practice and clinical trials. Raven Press, New York, pp 301–322Google Scholar
  55. 55.
    Vander Stichele R (1991) Measurement of patient compliance and the interpretation of randomized clinical trials. Fur J Clin Pharmacol 41:27–35Google Scholar
  56. 56.
    Vinson JM, Rich MW, Sperry JC, Shah AS, McNamara T (1990) Early re-admission of elderly patients with congestive heart failure. J Am Geriatr Soc 38:1290–1295Google Scholar
  57. 57.
    Weber E (1985) Folgen inadäquater Therapic unter Berücksichtigung der Non-Compliance. Arzneimitteltherapie 2: [Suppl 1]:54–59Google Scholar
  58. 58.
    Weintraub M, An WYM, Lasagna L (1973) Compliance as a determinant of serum digoxin concentration. JAMA 224:481–485Google Scholar

Copyright information

© Springer-Verlag 1992

Authors and Affiliations

  • W. Kruse
    • 1
  1. 1.Krankenhaus Bethanien und Abteilung für Klinische PharmakologieMedizinische Universitätsklinik HeidelbergHeidelbergGermany

Personalised recommendations