Issue 47 / 3 December 2012

A US study showing a telephone call and follow-up letter to patients will boost medication adherence is reassurance that a brief intervention often does the trick, according to Australian GPs.

The study, published in the Archives of Internal Medicine, found a simple automated intervention method (telephone call and follow-up letter) was effective in reducing primary non-adherence to statin medications by 16%. (1)

“Given how common primary nonadherence appears to be for chronic diseases, if similar results are realized for different medications and conditions, the population effect is potentially large”, the authors wrote.

In the randomised controlled trial, more than 5000 adult members of the Kaiser Permanente health insurance plan in Southern California were passively enrolled through electronic medical records if there had been no statin use within the past year and they had been prescribed a statin, but had not filled the prescription within 1–2 weeks of receiving it.

After enrolment, members of the intervention group received an automated telephone call followed 1 week later by a letter if non-adherence continued, reinforcing the reasons to use the medication. The control group received usual care.

Statins were subsequently dispensed to 42.3% of intervention participants and 26% of control participants.

“The suitability for outreach to large populations makes this an attractive strategy to help reduce the numbers of patients with primary nonadherence and better target those who remain nonadherent with complementary, more resource-intensive programs”, the researchers wrote.

Associate Professor Frank Jones, a GP and spokesman for the Royal Australian College of General Practitioners, told MJA InSight improving communication was the key in encouraging patients to adhere to their medications.

GPs should provide patients with diagrams, leaflets and written lists of what medications they were taking and why, particularly given patients only retained 10%–20% of what doctors told them during a visit, Professor Jones said.

Dr Oliver Frank, a GP and lecturer in general practice at the University of Adelaide, said patients should be educated about the significance of their health problem and how a medicine could help.

“This is because we know that patients are more likely to buy prescribed or recommended medicines and to take them if they understand how the medicine can help them”, he said.

Dr Justin Coleman, GP and online blogger, said improved adherence to medications by patients began with good communication at the time of prescribing, with regular follow-up and perhaps some “lateral thinking”.

“Recruit a family member, switch to a blister pack, or ask the patient to bring in their empty pill packets to show the practice nurse while waiting for the doctor”, he said.

However, Dr Coleman said he did not think a prerecorded phone message or form letter would work in Australia because doctors had no automated method of finding out if a script had been filled.

Dr Frank said the imminent introduction of widespread electronic transfer of prescriptions would enable doctors to monitor whether prescribed medicines were dispensed and to be alerted automatically if they had not.

However, it was still up to patients to decide whether they wished to have the medicine dispensed, he said.

Dr Edwin Kruys, a GP at the Panaceum Group in Geraldton, WA, said it was important to explain to patients that it might take time to find the suitable medication.

Older patients could be prompted to take their medication by Webster-paks, dispensing devices that beeped with flashing lights to alert them it was time to take their pills, or medication prompts from home nursing services or family members, he said.

Dr Kruys said there was a useful iPhone app by NPS Medicinewise that prompted people to take antibiotics. Doctors were good at adapting and it was always useful to try to improve existing methods, he said.

However, Dr Kruys said he wanted his patients “to take ownership of their health”.

“How far do health professionals have to go to prompt patients?” he said.

An invited commentary in Archives of Internal Medicine said the study findings “challenge clinicians and health systems to design, implement, and evaluate interventions to address primary nonadherence and improve patient health”. (2)

-Amanda Saunders

1. Arch Intern Med 2012; Online 26 November
2. Arch Intern Med 2012; Online 26 November

Posted 3 December 2012

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