Swallowing Pills on Schedule
From the annual American Heart Association meeting in Chicago: Part one in a series of web-exclusive articles
Patients who don't take their medications drive doctors crazy. "We spend billions of dollars developing new drugs," says military cardiologist Allen Taylor. "You'd think we could spend a little money getting people to take them." At least half of all patients are guilty of this, and an aging population on more medications will only make matters worse. Taylor's answer: patient education, blister packs, and more education.
Today at the American Heart Association annual meeting in Chicago, Taylor and colleagues at Walter Reed Army Medical Center in Washington, D.C., released a study describing an approach that pushed patient compliance to 95 percent.
The guinea pigs were 200 elderly people on an average of nine different medications because of chronic conditions such as heart disease or diabetes. An observation period showed that almost 40 percent of them did not take their medications as they were supposed to.
In the study, published Monday in the online edition of the Journal of the American Medical Association, pharmacists sat down with the patients to go through their medications, review the importance of taking them, and provide a two-month supply. The drugs came not in bottles, but on sheets studded with 31 large plastic blisters, one blister for each day of the month. Each blister was stuffed with all the pills to be taken on that day at a particular time—in the morning, for example. A second sheet was furnished if the patient had to take medications at a second time of day, and a third, if necessary, for another daily dosing.
Six months later, compliance had soared from 61 percent to 97 percent.
The patients then were placed at random into one of two groups. Those in the first group went back to pills in bottles and no counseling; those in the second met individually with a pharmacist every two months and got their medications in the blister packs. Fourteen months later, the first group had slumped back to 69 percent compliance, but the second had stayed at 96 percent. And the blood pressure of the compliant group had dropped significantly, while that of the other group had not changed.
The major cost, says Taylor, is for pharmacists to run the program and educate patients. He believes one pharmacist would have to be added for roughly every 200 patients. And while the materials cost of the blister packs is trivial—he puts it at 14 cents a sheet—stuffing the blisters is not. The member of the study team who had to do the job estimates that it took her about an hour and a half to assemble two months' worth of sheets for patients in the study taking drugs three times a day. "That should be a reason to develop a computerized system," counters Taylor. "Wouldn't it be worth it?"
Compliance Statistics: http://jrnlappliedresearch.com/articles/Vol3Iss3/Wertheimer.htm