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Reminder devices seem not to improve drug compliance, trial finds

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2176 (Published 04 May 2017) Cite this as: BMJ 2017;357:j2176

Rapid Response:

Improve drug compliance

I´m not surprised about the results of the trial [1,2] that reminder devices seem not to improve drug compliance.

The problems of medication adherence and compliance are complex [3]. There is a large variation in reported drug adherence (about 50%) between illness differences, patient groups [3] and drug classes, respectively. Side effects were the most common problems [4]; other relevant factors were the beliefs about the dangers of dependence or long-term effects [5]. There is evidence for the complexity of understanding the relationship between health care trust, mistrust and patient-related health behaviors [6] and the interaction between patient and physician.

The most important factor is to talk with the patient about compliance problems and possible adverse drug events at every visit and, if necessary to use (psycho-) educative training for patients The medication adherence rate is the proportion of prescribed drug doses consumed within a given time period. One way to improve adherence is reduce the intake of oral medicine once daily, to use Long-Acting Release Formulations -- for example, in Psychiatry Long-Acting Injectable antipsychotics for schizophrenia [7]. Another relevant point is to use consequently therapeutic drug monitoring (TDM), which involves measuring drug concentrations in blood/serum. The cost-benefit analyses are evident.

References:
1) Choudhry N, et al. Effect of reminder devices on medication adherence: the REMIND randomized clinical trial. JAMA Intern Med2017;357:624-31
2) Wise J BMJ. 2017;357:j2176
3) Pellowski JA et al. The differences between medical trust and mistrust and their respective influences on medication beliefs and ART adherence among African-Americans living with HIV. Psychol Health. 2017 May 5:1-13
4) Foot H et al. The necessity-concerns framework predicts adherence to medication in multiple illness conditions: A meta-analysis. Patient Educ Couns. 2016 May;99(5):706-17
5) Mahan KR et al. Development of a Tool to Identify Problems Related to Medication Adherence in Home Healthcare Patients. Home Healthc Now. 2017 May;35(5):277-82
6) Horne R, Weinman J. Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res. 1999 Dec;47(6):555-67
7) McCreath J et al. Long-Acting Injectable Antipsychotics for Schizophrenia: Sociodemographic Characteristics and Treatment Adherence. Prim Care Companion CNS Disord. 2017 Feb 23;19(1)

Competing interests: No competing interests

09 May 2017
Detlef Degner
Psychiatrist
Department of Psychiatry, University of Göttingen, Germany
Von-Siebold-Str 5, D-37075 Goettingen, Germany