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6/15/2001

After MI, Compliance Rises With Number of Medications

Kate Traynor

University of Michigan researchers say that the patients who best adhere to their medication regimen after a myocardial infarction, hospitalization, and standardized discharge counseling are those who use the largest number of medicines.

After suffering an acute myocardial infarction, adults who reported using the most medications were more likely than other patients to still be taking an appropriate beta blocker, angiotensin-converting-enzyme inhibitor, anticoagulant, or lipid-lowering drug six months after release from the hospital, said Steven R. Erickson, Pharm.D., BCPS, an assistant professor involved with the project. The research team also found a trend between the seriousness of the medical condition and compliance—the sicker the patient, the better the person's adherence with therapy. An abstract describing these findings has been submitted to the American Heart Association for presentation at a conference this fall.

In all, 36 percent of the 216 study participants reported some degree of noncompliance with their medication regimen six months after release from the hospital. Erickson acknowledged that overall medication compliance in this study was disappointingly low. A key difference, he said, between this recent study and an earlier one—in which patients reported up to 97 percent adherence with therapy six months after a myocardial infarction—is the way the questions were posed to patients.

In the earlier study, patients were contacted by telephone and asked which medications were being taken. "We asked them to get the bottles and bring them to the phone and read [the labels] to us," Erickson said. "The...study just examined 'Do you have the bottles there?'"

The recent study, he said, delved into whether the patients took their medications as directed. Patients who participated in this project were asked to indicate, on a scale from 1 to 5, their agreement with four questions related to compliance with therapy.

"The first question," Erickson said, was "Have you been careless about taking your heart medicine?" Patients were also asked whether they had forgotten to take their medicine, stopped taking it, or used less than prescribed because they "felt better." Any response other than a 5 indicated noncompliance.

"Surprisingly, when you give a person a set of questions like this in a 5-point scale...that says most of the time all the way down to none of the time, people will...tell you now and again that they’re not perfect," Erickson said. Although that style of inquiry reduced the patients’ reported compliance rates, he said the results are "much more truthful" than those obtained from counting patients’ medication bottles.

Erickson is interested in finding new ways to help patients adhere to their medication regimens.

"The compliance literature is old," he said. "It’s been around a long time, and we just keep rehashing the same thing over and over again. It boils down to complexity of regimen, health beliefs....It would be nice to be able to...take patient-specific or patient-targeted interventions related to improving compliant behavior."

Erickson speculated that the increase in compliance seen in the patients who used more medications may mean that patients reassess their habits after having a myocardial infarction. "Six months after a major event, perhaps their health beliefs have been altered enough to change their lifestyle, which would include taking their medications as prescribed," he said. After such a life-altering event, "it’s time to really educate [patients] and really change their beliefs," he said.

Although the patient part of the compliance equation needs work, Erickson pointed to one bright spot revealed during the study: "We were pleasantly surprised...at least at six months, how many patients were receiving appropriate therapy...based on guidelines."