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What is the patient's lifestyle like?
- Eiichiro Sando (19 May 2008)
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Re: What is the patient's lifestyle like?
- Bernard Vrijens, John Urquhart (28 May 2008)
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Eiichiro Sando, The department of General Internal Medicine and Infectious diseases Kameda Medical Center 929 Higashi-cho, Kamogawa, Chiba, 296-8602
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The article "Adherence to prescribed antihypertensive drug treatments" by Bernard Vrijens et al is certainly interesting and clinically significant. As a generalist, I have a number of patients who have prescribed antihypertensive drugs. But surely I have also the problem of "adherence". Patients sometimes tend to suppress their rest drugs. It is very important to give consideration to patients' lifestyle, especially what they do in during the day; housekeeping, sedentary, fishing, and so on. The fisher may eat his breakfast at 3 a.m. Some business people may not eat their breakfast. Patients' lifestyle may also contribute their adherence. Morning dosing is just good for the patients who eat their breakfast. Competing interests: None declared |
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Bernard Vrijens, Chief Scientist 4600 Visé, Belgium, John Urquhart
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Dr Sando’s query is apt. Previous work (1) indicates the importance of helping each patient link drug dosing to a robust routine in his/her daily life. Picking which routine is an individual matter, and may be considered a cornerstone of ‘personalized medicine’. Having picked a routine and established a practical way to link dosing to that routine, the logical next question is: does it actually achieve punctual execution of the daily dosing regimen? The answer is revealed by the patient’s subsequent dosing history. The process is called ‘measurement-guided medication management’, based on reliable means of compiling the times of daily dosing, and sound analysis thereof. If satisfactory adherence hasn’t been achieved, one must learn why, and switch to another robust routine, and continue to measure and analyze until satisfactory adherence is achieved and maintained. Learning which day of the week shows the most dosing errors can guide ‘fine tuning’ of integration of dosing into the patient’s daily life – step 2 in ‘personalized medicine’. Then, with correct dosing achieved, the drug’s effect on blood pressure indicates whether the choice of drug is optimal, or perhaps another drug should be tried – step 3 in ‘personalized medicine’. The principle is to evaluate drug actions at full adherence, so that individual differences in pharmacological actions of the drugs are clearly evident and not confounded by erratic dosing. Reference: 1. Cramer JA, Rosenheck R. Enhancing medication compliance for people with serious mental illness. J NervMent Dis 1999;187:53-5. Competing interests: Same as listed in the original paper |
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