Daily regimen and compliance with treatment

doi:10.1136/bmj.324.7334.425

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All available evidence needs to be evaluated

Knut Schroeder (k.schroeder@bristol.ac.uk), Medical Research Council training fellow in health services research, division of primary health care,
Shah Ebrahim, professor in epidemiology of ageing, department of social medicine,
Tom Fahey, senior lecturer in general practice, division of primary health care,
Alan Montgomery, Medical Research Council fellow in health services research, department of primary health care,
Tim Peters, reader in medical statistics, department of social medicine

University of Bristol, Bristol BS8 2PR
Department of Psychiatry, St George's Hospital Medical School, London SW17 0RE
Redcrest, Heath Rise, Camberley, Surrey GU15 2ER

EDITOR—Bloom's editorial is a surprising contribution to the important discussion about how best to improve compliance with treatment in chronic diseases.1 His assertion that fewer daily doses increase compliance, and his notion that the least expensive drugs are usually the least effective and have the highest rate of side effects, cannot go unchallenged.

Bloom cites one of his own studies, funded by a pharmaceutical company, to support the idea that fewer daily doses improve compliance.2 This study was a retrospective analysis of prescription records, which showed higher rates of prescription refill at one year among those treated with once daily versus more frequent dosing and those treated with newer, more expensive drugs. The study was confined to supposedly hypertensive patients younger than 71, but no initial blood pressure values were available, and none of them was evaluated in a standardised manner. Moreover, no blood …