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Improving compliance

Systematic review
Results
Comment

Most people do not take the medicines they are prescribed, and the obvious thing is to find ways of improving this. Two systematic reviews [1, 2] have found that interventions to improve compliance or adherence are pretty ineffective, and even those that are effective do not improve adherence by much. The problem of knowing what, if anything, to do is compounded by relative poverty of studies, in terms of their size and validity. A new review [3] concentrating on older patients in the community is a useful place to look at the problems.

Systematic review

Randomised trials of interventions aimed at improving medication adherence were sought in a variety of electronic databases. Results had to be on patients aged 60 years or older with a mean age of over 70 years who were living in the community. Total study size for all patients had to be above 50.

Results

Single generalised interventions were used in seven studies. Most were small, with numbers for intervention groups generally below 50 patients, and usually below 20 patients. In only one was the effect of the intervention measured at more than eight weeks. In one six-month study the numbers in intervention groups were about 20 patients. No single study was of a large enough size or long enough duration to be informative.

Three or more generalised or multifaceted interventions were used in eight studies. In five studies the duration was three months or longer and they were of reasonable size, with intervention or control group sizes of 50 or more in four of these five studies. In two of these there was a statistically significant improvement in an intervention group, but in neither was the magnitude of the benefit large.

Comment

In truth we know next to nothing about how to improve compliance with treatment in older patients. Yes, some studies show a significant effect, but not a big effect, and with little by way of utility to extrapolate elsewhere. The best we can say is that (possibly) multifaceted interventions involving a pharmacist help a bit.

References:

  1. Roter et al. Effectiveness of interventions to improve patient compliance: a meta-analysis. Medical Care 1998 36: 1138-1161.
  2. RB Haynes et al. Interventions for helping patients to follow prescriptions for medications (Cochrane Review). In: The Cochrane Library, 2002. Chichester, UK: John Wiley & Sons, Ltd.
  3. M van Eijken et al. Interventions to improve medication compliance in older patients living in the community. A systematic review of the literature. Drugs Aging 2003 20: 229-240.

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