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Review
. 2008 Jan;62(1):76-87.
doi: 10.1111/j.1742-1241.2007.01630.x. Epub 2007 Nov 5.

The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review

J A Cramer  1 , A Benedict, N Muszbek, A Keskinaslan, Z M Khan
Affiliations
Review

The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review

J A Cramer et al. Int J Clin Pract. 2008 Jan.

Abstract

Objectives: To review studies of patient compliance/persistence with cardiovascular or antidiabetic medication published since the year 2000; to compare the methods used to measure compliance/persistence across studies; to compare reported compliance/persistence rates across therapeutic classes and to assess whether compliance/persistence correlates with clinical outcomes.

Methods: English language papers published between January 2000 and November 2005 investigating patient compliance/persistence with cardiovascular or antidiabetic medication were identified through searches of the MEDLINE and EMBASE databases. Definitions and measurements of compliance/persistence were compared across therapeutic areas using contingency tables.

Results: Of the 139 studies analysed, 32% focused on hypertension, 27% on diabetes and 13% on dyslipidaemia. The remainder covered coronary heart disease and cardiovascular disease (CVD) in general. The most frequently reported measure of compliance was the 12-month medication possession ratio (MPR). The overall mean MPR was 72%, and the MPR did not differ significantly between treatment classes (range: 67-76%). The average proportion of patients with an MPR of >80% was 59% overall, 64% for antihypertensives, 58% for oral antidiabetics, 51% for lipid-lowering agents and 69% in studies of multiple treatments, again with no significant difference between treatment classes. The average 12-month persistence rate was 63% and was similar across therapeutic classes. Good compliance had a positive effect on outcome in 73% of the studies examining clinical outcomes.

Conclusions: Non-compliance with cardiovascular and antidiabetic medication is a significant problem, with around 30% of days 'on therapy' not covered by medication and only 59% of patients taking medication for more than 80% of their days 'on therapy' in a year. Good compliance has a positive effect on clinical outcome, suggesting that the management of CVD may be improved by improving patient compliance.

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Figures

Figure 1
Figure 1
Definitions of medication compliance and persistence proposed by the Issues and Methods Definitions Working Group of the Medication Compliance and Persistence Special Interest Group (15)
Figure 2
Figure 2
Source of compliance data over time
Figure 3
Figure 3
Persistence rates from the different studies, showing a significant trend (p < 0.001) towards decreased persistence with time
See this image and copyright information in PMC

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Appendix. Studies included in the systematic review

    1. Abraha I, Montedori A, Stracci F, Rossi M, Romagnoli C. Statin compliance in the Umbrian population. Eur J Clin Pharmacol. 2003;59:659–61. Epub 24 September 2003. - PubMed
    1. Abughosh SM, Kogut SJ, Andrade SE, Larrat P, Gurwitz JH. Persistence with lipid-lowering therapy: influence of the type of lipid-lowering agent and drug benefit plan option in elderly patients. J Manag Care Pharm. 2004;10:404–11. - PMC - PubMed
    1. Akpa MR, Agomuoh DI, Odia OJ. Drug compliance among hypertensive patients in Port Harcourt, Nigeria. Niger J Med. 2005;14:55–7. - PubMed
    1. Andrejak M, Genes N, Vaur L, Poncelet P, Clerson P, Carre A. Electronic pill-boxes in the evaluation of antihypertensive treatment compliance: comparison of once daily versus twice daily regimen. Am J Hypertens. 2000;13:184–90. - PubMed
    1. Artinian NT, Harden JK, Kronenberg MW, Vander Wal JS, Daher E. Pilot study of a web-based compliance monitoring device for patients with congestive heart failure. Heart Lung. 2003;32:226–33. - PubMed

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