Reminders not effective for medication compliance, study says

August 14, 2001

COLUMBUS, Ohio - Mail and telephone reminders to encourage patients to take their prescription medication as directed may be a pointless exercise, a new study suggests.

One out of five patients who were frequently reminded did not take their medication as prescribed - about the same proportion as those patients who did not receive special reminders.

The research included more than 4,500 subjects taking pravastatin, a cholesterol-lowering drug prescribed to patients at risk for a first heart attack.

The same results also showed that those patients who complied with their medication regimen were more likely to reduce risk factors that contribute to cardiovascular disease, factors such as adopting better eating habits and getting regular exercise.

"Health care providers, third-party payers and health care policymakers should take note that costly extra measures to ensure compliance don't appear to have an effect," said Robert Guthrie, study author and a professor of emergency medicine at Ohio State University.

Past research has found that, in the United States, non-compliance with prescription medication causes 125,000 deaths and costs an estimated $75.6 billion yearly.

The new study, published in a recent issue of the journal Clinical Therapeutics, included 4,548 patients participating in the First Myocardial Infarction Risk Reduction Program, a nationwide program to assist family doctors in evaluating and modifying risk factors for coronary artery disease. The patients were recruited by their family physicians.

Guthrie divided the participants into two groups: 3,635 subjects received telephone reminders at weeks two and eight and a reminder postcard at week four. The reminders stressed the importance of following the doctor's orders to reduce coronary risk behaviors and also asked patients to take their pravastatin as prescribed.

All of the patients, including the 913 subjects not receiving the early reminders, received reminder postcards during the fourth and fifth months after enrolling in the sixth-month study.

Patients completed survey forms at three and six months. They were asked about their compliance with the pravastatin prescription and if they had changed certain health behaviors.

At six months, 79.7 percent of the patients in the intervention group reported that they were taking pravastatin as prescribed, compared with 77.4 percent of those who received usual care.

"According to patients, the telephone and postal reminders did very little to improve their compliance or encourage risk-reducing lifestyle changes," Guthrie said.

"Doctor-patient relationships drive compliance, not postal and telephone reminders."

But the survey results did show that patients who did comply better with their medication therapy were more likely to adopt other coronary risk-reducing behaviors.

Of the 3,604 patients reporting compliance with pravastatin therapy - this group included patients who did and did not receive the reminders - 97.5 reported visiting their physician on a regular basis (vs. 82 percent of the 690 patients who weren't compliant); 62 percent changed their eating habits, vs. 51 percent of non-compliants; 41 percent increased physical activity, vs. 31 percent of non-compliants; 39 percent lost weight, vs. 35 percent of non-compliants; and 42 percent had improved their blood pressure, vs. 33.5 percent of non-compliants.
Written by Holly Wagner, 614-292-8310;

Ohio State University

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