Peer-Reviewed Compliance Studies

Patients who have difficulty maintaining adequate adherence need more intensive strategies than do patients who have less difficulty with adherence, a more forgiving medication regimen, or both. Innovative methods of managing chronic diseases have had some success in improving adherence when a regimen has been difficult to follow. New technologies such as reminders through cell phones and personal digital assistants and pillboxes with paging systems may be needed to help patients who have the most difficulty meeting the goals of a regimen.

The objective of this study was to evaluate the impact of medication adherence on healthcare utilization and cost for 4 chronic conditions that are major drivers of drug spending: diabetes, hypertension, hypercholesterolemia, and congestive heart failure.For diabetes and hypercholesterolemia, higher medication costs were more than offset by medical cost reductions, producing a net reduction in overall healthcare costs. For diabetes, hypercholesterolemia, and hypertension, cost offsets were observed for all-cause medical costs at high levels of medication adherence. For all 4 conditions, hospitalization rates were significantly lower for patients with high medication adherence.

Computerized reminder systems do improve the delivery of preventive services in family practice.  Note that telephone reminders were significantly more effective than letter reminders among men 15-44 years.

Evidence from randomized controlled studies supports the effectiveness of data-driven computer-based reminder systems to improve prevention services in the ambulatory care setting.

Patients who participated in the The Asheville Project, a program in which pharmacists coached patients on how to self-manage their diabetes, had significant improvement in clinical indicators of diabetes management, higher rates of self-management goal setting and achievement, and increased satisfaction with diabetes care. Employers experienced a decline in mean projected total direct medical costs. Total mean health care costs per patient were $918 lower than projections for the initial year of enrollment.

J Am Pharm Assoc. 2005;45:130–137

Daniel G. Garrett and Benjamin M. Blum

http://www.ncpharmacists.org/associations/4188/files/AshevilleDiabetes2.pdf

This study was designed to assess the persistence of outcomes for up to 5 years following the initiation of the The Asheville Project, a program of community-based pharmaceutical care services (PCS) for patients with diabetes. Mean A1c decreased at all follow-ups, with more than 50% of patients demonstrating improvements at each time. The number of patients with optimal A1c values (< 7%) also increased at each follow-up. More than 50% showed improvements in lipid levels at every measurement. Costs shifted from inpatient and outpatient physician services to prescriptions, which increased significantly at every follow-up. Total mean direct medical costs decreased by $1,200 to $1,872 per patient per year compared with baseline. Patients with diabetes who received ongoing PCS maintained improvement in A1c over time, and employers experienced a decline in mean total direct medical costs.

Journal of the American Pharmaceutical Association 2003 Mar-Apr;43(2):173-84

Barry A. Bunting and Carole W. Cranor, DB Christensen

Comparative Study

In the first 4 weeks of the study when calls were daily, very few phone calls or medications were reported missed. In the following 4 weeks were calls were tapered to weekdays only, few calls and few medications were missed. Overall, the subjects that did not experience institutionalization or major chaotic life changes did very well receiving phone calls, and did well with adherence to medication doses.

Some of the most effective behavioral strategies include tailoring the medical regimen to the patient's daily routine and lifestyle. A final intervention found to be quite successful in improving and maintaining high levels of adherence to medical recommendations is that of social support, either from a health care professional or within one's personal environment.

Few participants eligible for the study had trouble identifying a support partner. Over 90% of support partners attended at least one intervention visit. Support partners were most available and amenable to participate early in the initiation of therapy. Participants' experiences as the 'supported' partner were generally positive. Though many participants faced barriers not easily addressed by this intervention (for example, housing instability), formally integrating support partners into the intervention helped to address many other common adherence barriers. Family and friends are an underutilized resource in HIV medication adherence. Enlisting the help of support partners is a practical and economical approach to adherence counselling.

G. Davies; L.J. Koenig; D. Stratford; M. Palmore; T. Bush; M. Golde E. Malatino; M. Todd-Turner; T. V. Ellerbrock

Patients with emergency department visits
decreased from 9.9% to 1.3%, and hospitalizations from 4.0% to 1.9%. Spending on asthma medications increased; however, asthma-related medical claims decreased and total asthma-related costs were significantly lower than the projections based on the study population’s historical trends. Direct cost savings averaged $725/patient/year, and indirect cost savings were estimated to be $1,230/patient/year. Indirect costs due to missed/nonproductive workdays decreased from 10.8 days/year to 2.6 days/year. Patients were six times less likely to have an emergency department/hospitalization event after program interventions.

Some of the most effective behavioral strategies include tailoring the medical regimen to the patient's daily routine and lifestyle. A final intervention found to be quite successful in improving and maintaining high levels of adherence to medical recommendations is that of social support, either from a health care professional or within one's personal environment.

The results of this study clearly demonstrate that in an outpatient mental health clinic, computer reminders were shown to be superior to manual reminders in improving adherence to a clinical practice guideline for depression

Dale S. Cannon and Steven N. Allen

The therapeutic relationship that a clinician builds with his or her patient is a cornerstone
of treatment compliance.  The most important factor influencing compliance was the
patient’s perception of the doctor’s interest in him or her, which is clearly reinforced by the amount of time that physicians spend with their patients. Such a relationship is a
prerequisite for a working therapeutic alliance, and providing reliable information is a
crucial factor in this context. Information can be given to patients and their relatives or
significant others, either informally during scheduled visits or in psychoeducational
groups. Providing information includes discussing treatment plans regularly with patients
and their significant others, which gives both an active part in the treatment planning process.

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&
TermToSearch
=14680413&ordinalpos=1&itool=EntrezSystem2.PEntrez.
Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum