Understanding patient management: the need for medication adherence and persistence
AbstractPoor patient adherence to medication is one of the major factors contributing to poor disease control, in particular inasymptomatic chronic diseases like hypertension and dyslipidaemia. The physical and economic burden on patients and thehealth care system as a result of non-adherence is great. It is estimated that poor adherence to hypertension medicationaccounts for as many as 7.1 million preventable deaths annually. Hence recognising and identifying non-adherence is thefirst step to addressing this problem. Medication adherence can be measured in various ways including self-report to electronicmonitoring. In order to be more successful in managing non-adherence, attention must be paid to barriers to adherence,namely the interplay of patient factors, the health care providers themselves and the health care system itself. Taking theseinto account will probably have the greatest impact on improving medication adherence. Consequently strategies to helpovercome these barriers are of paramount importance. Some of these strategies will include education of patients, improvingcommunication between patients and health care providers, improving dose scheduling, providing drugs with less adverseeffects, and improving accessibility to health care. Poor mediation adherence continues to be a huge challenge. While thepatient is ultimately responsible for the taking of medication, good communication, involving the patient in decision makingabout their care and simplifying drug regimens go a long way in improving it.
Burnier M. Medication adherence and persistence as the cornerstone of effective antihypertensive therapy. Am J Hypertens. 2006;19(11): 1190-6.
Burt VL, Whelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988-1991. Hypertension. 1995;25(3): 305-13.
Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988-2000. JAMA. 2003;290(2):199-206.
Sabate E. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization, 2003. Available from: http://whqlibdoc.who.int/publications/2003/9241545992.pdf (accessed 30 March 2008).
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Available from: http://www.nhlbi.nih.gov/guidelines/hypertension (accessed 30 March 2008).
Burnier M, Schneider MP, Chiolero A, et al. Electronic compliance monitoring in resistant hypertension: the basis for rational therapeutic decisions. J Hypertens. 2001;19(2):335-41.
McCombs JS, Nichol MB, Newman CM,Sclar DA. The costs of interrupting antihypertensive drug therapy in a Medicaid population. Med Care. 1994; 32(3):214-26.
Nelson MR, Reid CM, Ryan P, Willson K, Yelland L, on behalf of the ANBP2 Management Committee. Compliance question linked to major cardiovascular disease outcomes. Clinical and Experimental Pharmacology and Physiology. 2006;33(Suppl):A20.
Waeber B, Leonetti G, Kolloch R, McInnes GT. Compliance with aspirin or placebo in the Hypertension Optimal Treatment (HOT) study. J Hypertens. 1999;17(7):1041-5.
Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001;23(8):1296-310.
Wetzels GEC, Nelemans P, Schouten JS, Prins MH. Facts and fiction of poor compliance as a cause of inadequate blood pressure control: a systematic review. J Hypertens. 2004;22(10):1849-55.
Benner JS, Glynn RJ, Mogun H, et al. Long-term persistence in use of statin therapy in elderly patients. JAMA. 2002; 288(4):455-61.
Urquhart J. The odds of the three nons when an aptly prescribed medicine isn’t working: non-compliance, non-absorption, non-response. Br J Clin Pharmacol. 2002;54(2):212-20.
Osterberg L, Blaschke T. Drug therapy: Adherence to medication. N Engl J Med. 2005;353(5):487-97.
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986; 24(1):67-74.
Roth HP, Caron HS: Accuracy of doctors’ estimates and patients’ statements on adherence to a drug regimen. Clin Pharmacol Ther. 1978;23(3):361-70.
Gilbert JR, Evans CE, Haynes RB, Tugwell P: Predicting compliance with a regimen of digoxin therapy in family practice. Can Med Assoc J. 1980;123(2):119-22.
Burnier M, Santschi V, Favrat B, Brunner HR: Monitoring compliance in resistant hypertension: an important step in patient management. J Hypertens. 2003;21(2):S37-S42.
Cramer JA, Mattson RH, Prevey ML, et al. How often is medication taken as prescribed? A novel assessment technique. JAMA. 1989;261(22):3273-77.
Schwed A, Fallab CL, Burnier M, et al. Electronic monitoring of compliance to lipid-lowering therapy in clinical practice. J Clin Pharmacol. 1999;39(4):402-9.
Balkrishnan R. Predictors of medication adherence in the elderly. Clin Ther. 1998;20(4):764-71.
Feinstein AR. On white-coat effects and the electronic monitoring of compliance. Arch Intern Med. 1990;150(7):1377-8.
Cramer JA, Scheyer RD, Mattson RH. Compliance declines between clinic visits. Arch Intern Med. 1990;150(7):1509-10.
Bloom BS. Continuation of initial antihypertensive medication after 1 year of therapy. Clin Ther. 1998;20(4):671-81.
Hasford JM. A population-based European cohort study of persistence in newly diagnosed hypertensive patients. J Hum Hypertens. 2002;16(8):569-75.