Predicted Improvements
The Research
Numerous studies have established the problem of noncompliance and its costs to patients, families, doctors and drug companies. Studies have examined a wide variety of patient conditions and diseases, different classes of drugs and packaging, and the relative efficacy of patient intervention strategies to improve medication compliance.
The central question is this: can psychosocial/behavioral interventions actually increase people’s compliance with their medication prescriptions? The answer is an unqualified "yes." Review of more than 40 studies conducted over a 25-year period conclusively demonstrates that personal intervention strategies significantly improve medication compliance beyond the level achieved through standard patient education and medical care. Meta-analytic statistical techniques have shown that the size of this effect, on average, is a 36% decrease in the base rate of noncompliance following an intervention. Interpersonal interventions produce an even greater effect—about a 45% decrease in noncompliance (Cook, 1999; Mullen, Green, & Persinger, 1985).
The State of the Art
Various psychosocial techniques have been used to improve compliance among patients with chronic conditions such as hypertension, epilepsy, congestive heart failure, bipolar disorder and schizophrenia. The persistent and costly nature of these conditions makes them ideal targets for compliance-enhancing interventions that can improve patient outcomes. Strategies in use include:
- Self-monitoring
- Family counseling
- Cognitive-behavioral treatment
- Assertiveness training
- Alternative packaging of drugs
- Motivational interviewing
- Reminders (e.g., mechanical devices such as beepers) and support
- Self- (or external) rewards
Our meta-analytic review (Cook, 1999) indicates that out of all the techniques studied so far, the most effective interventions involve asking participants to monitor their own medication habits, enlisting support from family members, and applying cognitive-behavioral techniques to target problematic beliefs and behaviors. In addition, interventions involving personal contact with a counselor are more helpful than purely "technological" interventions involving efficient packaging or automatic reminders.
The Benefits of Improving Compliance
Regardless of the type of drug targeted, increasing levels of prescription adherence helps patients avoid the enormous costs of noncompliance. The application of compliance-enhancing interventions has a significant positive impact on drug treatment outcomes, patient and physician satisfaction, and drug brand success.
| Drug Type | Base Rate of Non-Persistency in Treatment (First Year) | Predicted Rate After Industry Standard "Technological" Intervention | Predicted Rate After ScriptAssist "Interpersonal" Intervention |
|---|---|---|---|
| AChE Inhibitors (dementia) | 89% | 63% | 49% |
| Proton Pump Inhibitors | 84% | 60% | 46% |
| Antiarrythmics | 80% | 57% | 44% |
| Bronchodilators (COPD) | 80% | 57% | 44% |
| Lipid-Lowering Agents | 72% | 51% | 40% |
| NSAIDs | 70% | 49% | 39% |
| Antihypertensives | 65% | 46% | 36% |
| Antidepressants | 61% | 43% | 34% |
| Antipsychotics | 60% | 42% | 33% |
| Migraine Medications | 56% | 40% | 31% |
| Anticonvulsants | 54% | 38% | 30% |
| Nonsedating Antihistamines | 44% | 31% | 24% |
| Immunosuppressants | 34% | 24% | 19% |
© 2000 ScriptAssist, LLC. Material may not be reproduced without permission from ScriptAssist. Information published herein is the opinion of the authors.
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