Source: Special Report: Interventions to Improve Patient Adherence with Medications for Chronic Cardiovascular Disorders. Technology Evaluation Center Assessment Program. Volume 18, No. 12. November 2003
The Report
This web page contains the Executive Summary to the Special Report: Interventions to Improve Patient Adherence with Medications for Chronic Cardiovascular Disorders1 and the link for downloading the full report in PDF format: Full Report Download
Few Patient Compliance Studies Meet Evidence-based Standards
The Report is a review of reviews of the apposite literature. After eliminating reviews that did not meet TEC’s evidence-based criteria, the authors of the Report include seven systematic reviews, which themselves analyze a total of 69 primary studies pertinent to compliance with cardiovascular medications.
The Findings – Single-strategy Compliance Enhancements Ineffective
Despite the comprehensiveness of the initial survey of the literature and the extensive database of studies finally considered, almost no evidence was found that the use of the wide range of compliance enhancements examined improved adherence rates.
The single exception to this disheartening trend is the Report’s finding that simplifying medication dosage schedules has demonstrable value in improving medication adherence.2
Otherwise, however, the evidence for compliance enhancement interventions is inadequate to draw conclusions or indicates that an intervention is ineffective.
One is forced to conclude that, with the exception of simplifying medication dosage schedules, no single-strategy, standalone behavioral interventions now in use (of those covered in this thorough study) can be expected to produce a significant positive effect.
Complex interventions are found more promising, but, as the Summary points out,
… many of the complex interventions are resource intensive, and may not be easily replicated or implemented in today’s environment. … Furthermore, it is not possible to determine which specific components of these complex strategies resulted in benefit, thus making it difficult to design pragmatic interventions.
Finally, the Summary notes that the quality of most of the primary studies is, euphemistically put, problematic. Many potential interventions, for example have not been adequately tested. Of special concern is the lack of comparisons of different interventions.
Commentary
While this report deals with medication compliance and chronic cardiovascular disorders, it reflects the lamentable state of affairs of patient compliance throughout healthcare.
- The report was produced by the Technology Evaluation Center (TEC), an agency founded by the Blue Cross and Blue Shield Association for the purpose of producing “evidence-based technology assessments … of the clinical effectiveness and appropriateness of a given medical procedure, device or drug.” TEC, according to the website, “serves a wide range of clients in both the private and public sectors, including Kaiser Permanente and the Centers for Medicare and Medicaid Services (CMS).”↩
- As I have noted before, doctors have been taught, at least as long ago as when I attended medical school in the 1970s, to simplify medication doses. Consequently, one wonders how much potential for further dosage schedule simplification exists. In any case, it seems that even vigorous implementation of this tactic will produce limited benefits in any given patient population.↩
