Summary
Compared to other variables being considered in therapeutics, patient compliance has long been given minor attention although it affects every aspect of medical care. Limited methodology of compliance measurement, in particular, has hampered major progress in research, and pre-conceptions have been reiterated. However, there is a recent surge in interest derived from new data revealed by reliable methods, i.g. continuous medication (compliance) monitoring. The visualization of dynamics in drug regimen compliance over time offers unique opportunities, both to scientific drug evaluation and therapeutics in medical practice. New perspectives related to the descriptive and explanatory side of the problem are outlined by giving examples from various therapeutic fields.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Anon (1991) Patient compliance in therapeutic trials. Lancet 337:823–824
Anon (1991) Helping patients to make the best use of medicines. Drug Ther Bull 29:1–2
Heilmann K, Herrmann M (1990) Patient and Arzneimittel. Arbeitsgemeinschaft Gesundheit und Gesellschaft des Institutes für Untersuchung technologischer and wirtschaftlicher Entwicklungen im Gesundheitswesen und der Infratest Gesundheitsforschung. München
Benet LZ (1990) Principles of prescription order writing and patient compliance instructions. In: Goodman Gilman A, Rall TW, Nies AS, Taylor P (eds) The pharmacological basis of therapeutics 8. Pergamon Press, Oxford New York, pp 1640–1649
Black DM, Brand RJ, Greenlick M, Hughes G, Smith J (1987) Compliance to treatment for hypertension in elderly patients: the SHEP Pilot Study. J Geront 42:552–557
Center for the Study of Drug Development. Tufts University (1989) Proceedings of the symposium on compliance monitoring. Woodbridge, NJ
Cheung R, Sullens CM, Seal D, Dickins J, Nicholson PW, Deshmukh AA, Denham MJ, Dobbs SM (1988) The paradox of using a 7 day antibacterial course to treat urinary tract infections in the community. Br J Clin Pharmac 26:391–398
Coats AJS, Adamopoulos S, Meyer TE, Conway J, Sleight P (1990) Effects of physical training in chronic heart failure. Lancet 335:63–66
Cramer JA (1991) Identifying and improving compliance patterns: a composite plan for health care providers. In: Cramer JA, Spilker B (eds) Patient compliance in medical practice and clinical trials. Raven Press, New York, pp 387–392
Cramer JA, Spilker B (eds) (1991) Patient compliance in medical practice and clinical trials. Raven Press, New York
Cramer JA, Collins JF, Mattson RH (1988) Can categorization of patient background problems be used to determine early termination in a clinical trial? Contr Clin Trials 9:47–63
Cramer JA, Mattson RH, Prevey ML, Scheyer RD, Quellette VL (1989) How often is medication taken as prescribed? A novel assessment technique. JAMA 261:3273–3277
Cramer JA, Scheyer RD, Mattson RH (1990) Compliance declines between clinical visits. Arch Intern Med 150:1509–1510
Drug Information Association (1989) The impact of partial compliance in clinical trials. Philadelphia
Efron B, Feldman D (1991) Compliance as an explanatory variable in clinical trials. J Am Stat Assoc 86:9–26
Engström F (1991) Clinical correlates of antidepressant compliance. In: Cramer JA, Spilker B (eds) Patient compliance in medical practice and clinical trials. Raven Press, New York, pp 187–194
Feinstein AR (1990) On white-coat effects and the electronic monitoring of compliance. Arch Int Med 150:1377–1378
Schmidt D, Leppik (1988) Compliance in epilepsy. Epilepsy Res [Suppl 1] Elsevier, Amsterdam New York Oxford
Proceedings of the first international symposium on compliance monitoring (1988) Heidelberg
Fischer B, Lehrl U, Fischer U, Weber E (1983) Drug compliance of progeriatric rehabilitation patients. Brief communication on a longitudinal investigation. Akt Gerontol 13:101–103
Goldsmith CH (1979) The effect of compliance distributions on therapeutic trials. In: Haynes RB, Taylor DW, Sackett DL (eds) Compliance in health care. The Johns Hopkins University Press, Baltimore London, pp 297–308
Gordis L (1979) Conceptual and methodologic problems in measuring patient compliance. In: Haynes RB, Taylor DW, Sackett DL (eds) Compliance in health care. The Johns Hopkins University Press, Baltimore London, pp 23–45
Gundert-Remy U, Möntmann U, Weber E (1978) Studien zur Regelmäßigkeit der Einnahme der verordneten Medikamente bei stationären Patienten. Inn Med 5:78–83
Harter JG, Peck CC (1991) Chronobiology: suggestions for integrating it into drug development. Ann NY Acad Sci 618:563–571
Hasford J (1991) Biometric issues in measuring and analyzing partial compliance in clinical trials. In: Cramer JA, Spilker B (eds) Patient compliance in medical practice and clinical trials. Raven Press, New York, pp 265–281
Haynes RB (1979) Introduction. In: Haynes RB, Taylor DW, Sackett DL (eds) Compliance in health care. The Johns Hopkins University Press, Baltimore London, pp 1–7
Haynes RB, Wang E, Da Mota Gomes M (1987) A critical review of interventions to improve compliance with prescribed medications. Pat Educ Counsel 10:155–166
Inui TS, Yourtee EL, Williamson JW (1976) Improved outcomes in hypertension after physician tutorials. A controlled trial. Ann Intern Med 84:646–651
Johnson BF, Whelton A, Mc Mahon FG (1991) Betaxolol versus atenolol in hypertension: a comparison of efficacy, duration of response, and effects of withdrawal. Am J Hypertens 3/II:121 A
Joyce CRB (1962) Patient co-operation and the sensitivity of clinical trials. J Chron Dis 15:1025–1036
Kass MA, Meltzer DW, Gordon M, Cooper D, Goldberg J (1986) Compliance with topical pilocarpine treatment. Am J Ophthalmol 101:515–523
Kruse W (1991a) Compliance with treatment of hyperlipoproteinernia in medical practice and clinical trials. In: Cramer JA, Spilker B (eds) Patient compliance in medical practice and clinical trials. Raven Press, New York, pp 175–186
Kruse W (1991b) Early readmission of elderly patients with congestive heart failure. J Am Geriatr Soc (in press)
Kruse W, Weber E (1990) Dynamics of drug regimen compliance — its assessment of microprocessor-based monitoring. Eur J Clin Pharmacol 38:561–565
Kruse W, Schlierf G, Weber E (1989) Dynamically compliance monitoring — its utility for the interpretation of drug trials. Eur J Clin Pharmacol 36 [Suppl A]:289
Kruse W, Schlierf G, Weber E (1990) Monitoring compliance in clinical trials. Lancet 335:803–804
Kruse W, Eggert-Kruse W, Rampmaier J, Runnebaum B, Weber E (1991) Dosage frequency and patients' drug-compliance behaviour — a comparative study on compliance with a medication to be taken twice or four times daily. Eur J Clin Pharmacol (in press)
Kruse W, Koch-Gwinner P, Nikolaus T, Oster P, Schlierf G (1991) Drug compliance behavior in geriatric patients after discharge from hospital. J Am Geriatr Soc (in press)
Lasagna L (1989) Pharmacometry in man: the state of the art. In: Lasagna L, Erill S, Naranjo CA (eds) Dose-response relationships in clinical pharmacology. Excerpta Medica, Amsterdam, pp 1–7
Lipid Research Clinics Program (1984) The Lipid Research Clinics Coronary Primary Prevention Trial results: II. The relationship of reduction in incidence of coronary heart disease and cholesterol lowering. JAMA 251:365–374
Mäenpää H, Manninen V, Heinonen OP (1987) Comparison of the digoxin marker with capsule counting and compliance questionnaire methods for measuring compliance to medication in a clinical trial. Eur Heart J 8 [Suppl 1]:39–43
Meichenbaum D, Turk DC (1987) Facilitating treatment adherence. Plenum Press, New York
Moulding T (1979) The unrealized potential of the medication monitor. Clin Pharmacol Ther 25:131–136
Mushlin AI, Appel FA (1977) Diagnosing potential noncompliance: physicians' ability in a behavioral dimension of medical care. Arch Intern Med 150:318–321
Norell SE (1981) Accuracy of patient interviews and estimates by clinical staff in determining medication compliance. Sec Sci Med 15 E:57–61
Norell SE (1983) Methods in assessing drug compliance. Acta Med Scand 213 [Suppl 683]:35–40
Norell SE, Granström P-A (1980) A medication monitor and fluorescein technique designed to study medication behaviour. Acta Ophthalmol 58:459–467
Pullar T, Kumar S, Tindall H, Feely M (1989) Time to stop counting the tablets? Clin Pharmacol Ther 46:163–168
Rudd P (1979) In search of the gold standard for compliance measurement. Arch Intern Med 139:627–628
Rudd P, Byyny RL, Zachary V, Lo Verde ME, Titus C, Mitchell WD (1989) The natural history of medication compliance in a drug trial: limitations of pill counts. Clin Pharmacol Ther 46:169–176
Rudd P, Ahmed S, Zachary V, Barton C, Bonduelle D (1990) Improved compliance measures: applications in an ambulatory hypertensive drug trial. Clin Pharmacol Ther 48:676–685
Schweizerische Gesellschaft für Pharmakologie und Toxikologie, Sektion Klinische Pharmakologie (1989) Variability in drug response: the problem of compliance. Basel
University of Leeds, Dept. of Clinical Pharmacology (1991) Workshop methods of measuring compliance: ‘Horses for courses?’ Symposium on compliance with drug therapy. Leeds
Urquhart J (1991) Patient compliance as an explanatory variable in four selected cardiovascular studies. In: Cramer JA, Spilker B (eds) Patient compliance in medical practice and clinical trials. Raven Press, New York, pp 301–322
Vander Stichele R (1991) Measurement of patient compliance and the interpretation of randomized clinical trials. Fur J Clin Pharmacol 41:27–35
Vinson JM, Rich MW, Sperry JC, Shah AS, McNamara T (1990) Early re-admission of elderly patients with congestive heart failure. J Am Geriatr Soc 38:1290–1295
Weber E (1985) Folgen inadäquater Therapic unter Berücksichtigung der Non-Compliance. Arzneimitteltherapie 2: [Suppl 1]:54–59
Weintraub M, An WYM, Lasagna L (1973) Compliance as a determinant of serum digoxin concentration. JAMA 224:481–485
Author information
Authors and Affiliations
Additional information
Dedicated to Prof. Dr. Dr. h.c. mult. Gotthard Schettler on the occasion of his 75th birthday
Rights and permissions
About this article
Cite this article
Kruse, W. Patient compliance with drug treatment — new perspectives on an old problem. Clin Investig 70, 163–166 (1992). https://doi.org/10.1007/BF00227361
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00227361