EFFORTS TO IMPROVE MEDICATION USE FALL FLAT

By Becky Ham, Staff Writer
Health Behavior News Service

Only 49 percent of intervention efforts, from special pill packaging to one-on-one counseling, improved patients' ability to stick to their prescription treatment. About 43 percent of the interventions significantly improved the treatment outcome, according to a study by Heather P. McDonald, B.Sc., and colleagues of McMaster University in Ontario, Canada, published in the Dec. 11 issue of the Journal of the American Medical Association.

As more individuals take responsibility for their own care for chronic conditions from asthma to HIV, adherence to prescription medicine regimes is critical, the study authors stress.

"Effective ways to help people follow medical treatments could have far larger effects on health care than any individual treatment," say McDonald and colleagues.

The researchers surveyed the medical literature for studies published between 1967 and 2001 that measured the effectiveness and outcome of measures designed to improve patient adherence to medication prescriptions.

These measures included written or verbal instructions on medication use, increased communication from automated telephone calls to family intervention, dosage reminders printed on drug packaging and increased convenience of care such as job-site pharmacies.

McDonald and colleagues analyzed 39 such measures for their study, including methods to handle short-term antibiotic treatment and long-term chronic conditions like high blood pressure, diabetes and psychiatric disorders.

Almost all the measures that were effective for long-term care were complex, consisting of multiple types of intensive interventions. For instance, a successful complex intervention plan for asthma patients included a set of information pamphlets, a self-help workbook, one-on-one counseling sessions, telephone calls and regular support group meetings.

But "even the most effective interventions did not lead to large improvements in adherence or treatment outcomes," say McDonald and colleagues.

The researchers suggest that patient adherence might be even worse than their findings indicated, since their data come from studies where patients attended regular appointments as part of their care.

This study was supported in part by the Population Health Information Project, the Canadian Institute of Health Research, the Kidney Foundation of Canada and Associated Medical Services/Wilson Postgraduate Fellowships.

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