Patients Unilaterally Stop and Re-Start Prescribed Medications

04-06-2007 | Categories:

Clinical Info

Gaps in Treatment Among Users of Osteoporosis Medications: The Dynamics of Noncompliance M. Alan Brookhart, Jerry Avorn, Jeffrey N. Katz, Joel S. Finkelstein, Marilyn Arnold, Jennifer M. Polinski, Amanda R. Patrick, Helen Mogun and Daniel H. The American Journal of Medicine Volume 120, Issue 3 , March 2007, Pages 251-256

Gaps In Medication Compliance

Study Parameters
Brookhart and colleagues studied 26,636 first-time users of an osteoporosis medication who were age 65 or older and had an extended lapse in refill compliance (i.e., one or more periods of at least 60 days after the completion of one prescription in which no refill for any osteoporosis medication was obtained).

Results
The following is excerpted from the abstract:

Of patients who stopped therapy for at least 60 days, an estimated 30% restarted treatment within 6 months, and 50% restarted within 2 years. Among patients who had at least 6 months of continuous use before their interruption in treatment (n = 5863), 42% restarted therapy within 6 months and 59% within 2 years. Younger patients, women, and those with a history of a fracture were more likely to return after a break in medication use. Recent hip fractures, discharges from nursing homes, and bone mineral density testing also predicted a return to treatment.

Commentary

This is a valuable study, if for no other reason than its support for the conceptualization of compliance/noncompliance as a spectrum rather than an all or nothing phenomenon. In this case the relevant variable is not the percentage of doses taken per doses prescribed but rather the periods of time during which the patient took at least a portion of the medication prescribed and those periods during which none of the medication was taken.

I do, however, think a significant distinction regarding the causes of shifts between noncompliance and compliance should be made. Dr. Brookhart opens the article with a statement of the study’s purpose:

Cyclical patterns of compliance have been observed with many health-related activities such as dieting and exercise. It is not known whether such patterns of compliance exist among users of chronic medications. We sought to estimate the percentage of patients who restart osteoporosis therapy after a prolonged lapse in medication use and to identify the factors associated with a return to compliance.

The analogy between cyclic compliance/noncompliance with dieting and exercise and gaps in compliance with medication is not, in my judgment, uniformly valid. As the results of this study indicate, many of the returns to compliance from periods of noncompliance were occasioned by specific events, such as fractures and bone mineral density tests, that would be described by Drucker and other business analysts as discontinuities in the environment. I find it difficult to list similar discontinuities in dieting and exercise that occur with any significant frequency other than New Year’s resolutions that fill local health clubs with exercisers for the first week of January and the time-limited bouts of intense dieting and exercise that precede and are preparation for certain occasions such as high school reunions.

I suspect that the significance of this distinction has less to do with the degree of similarity or dissimilarity between, for example, following a standard diet (i.e., a diet that is not part of a treatment for a specific disorder) and following a osteoporosis medication regimen than it does with the erroneous assumption that “Compliance” describes a unitary process.

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