Patient compliance with drug treatment — new perspectives on an old problem
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 evaluationPreview
Unable to display preview. Download preview PDF.
References
- 1.Anon (1991) Patient compliance in therapeutic trials. Lancet 337:823–824Google Scholar
- 2.Anon (1991) Helping patients to make the best use of medicines. Drug Ther Bull 29:1–2Google Scholar
- 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.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.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.Center for the Study of Drug Development. Tufts University (1989) Proceedings of the symposium on compliance monitoring. Woodbridge, NJGoogle Scholar
- 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.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.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.Cramer JA, Spilker B (eds) (1991) Patient compliance in medical practice and clinical trials. Raven Press, New YorkGoogle Scholar
- 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.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.Cramer JA, Scheyer RD, Mattson RH (1990) Compliance declines between clinical visits. Arch Intern Med 150:1509–1510Google Scholar
- 14.Drug Information Association (1989) The impact of partial compliance in clinical trials. PhiladelphiaGoogle Scholar
- 15.Efron B, Feldman D (1991) Compliance as an explanatory variable in clinical trials. J Am Stat Assoc 86:9–26Google Scholar
- 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.Feinstein AR (1990) On white-coat effects and the electronic monitoring of compliance. Arch Int Med 150:1377–1378Google Scholar
- 18.Schmidt D, Leppik (1988) Compliance in epilepsy. Epilepsy Res [Suppl 1] Elsevier, Amsterdam New York OxfordGoogle Scholar
- 19.Proceedings of the first international symposium on compliance monitoring (1988) HeidelbergGoogle Scholar
- 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.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.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.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.Harter JG, Peck CC (1991) Chronobiology: suggestions for integrating it into drug development. Ann NY Acad Sci 618:563–571Google Scholar
- 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.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.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.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.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.Joyce CRB (1962) Patient co-operation and the sensitivity of clinical trials. J Chron Dis 15:1025–1036Google Scholar
- 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.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.Kruse W (1991b) Early readmission of elderly patients with congestive heart failure. J Am Geriatr Soc (in press)Google Scholar
- 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.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.Kruse W, Schlierf G, Weber E (1990) Monitoring compliance in clinical trials. Lancet 335:803–804Google Scholar
- 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.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.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.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.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.Meichenbaum D, Turk DC (1987) Facilitating treatment adherence. Plenum Press, New YorkGoogle Scholar
- 43.Moulding T (1979) The unrealized potential of the medication monitor. Clin Pharmacol Ther 25:131–136Google Scholar
- 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.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.Norell SE (1983) Methods in assessing drug compliance. Acta Med Scand 213 [Suppl 683]:35–40Google Scholar
- 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.Pullar T, Kumar S, Tindall H, Feely M (1989) Time to stop counting the tablets? Clin Pharmacol Ther 46:163–168Google Scholar
- 49.Rudd P (1979) In search of the gold standard for compliance measurement. Arch Intern Med 139:627–628Google Scholar
- 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.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.Schweizerische Gesellschaft für Pharmakologie und Toxikologie, Sektion Klinische Pharmakologie (1989) Variability in drug response: the problem of compliance. BaselGoogle Scholar
- 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.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.Vander Stichele R (1991) Measurement of patient compliance and the interpretation of randomized clinical trials. Fur J Clin Pharmacol 41:27–35Google Scholar
- 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.Weber E (1985) Folgen inadäquater Therapic unter Berücksichtigung der Non-Compliance. Arzneimitteltherapie 2: [Suppl 1]:54–59Google Scholar
- 58.Weintraub M, An WYM, Lasagna L (1973) Compliance as a determinant of serum digoxin concentration. JAMA 224:481–485Google Scholar