Evidence‐based interventions to improve patient compliance with antihypertensive and lipid‐lowering medications

The MEDLINE database was searched from 1972 to June 2002 to identify studies of interventions designed to improve compliance with antihypertensive or lipid‐lowering medications. Studies were required to employ a controlled design, follow patients for ≥6 months and measure compliance by a method other than patient self‐report. The literature review yielded 62 studies describing 79 interventions. Overall, 56% of interventions were reported to improve patient compliance. When only those studies meeting minimum criteria for methodological quality were considered, 22 interventions remained and 12 were recommended, because they demonstrated a significant improvement in compliance. Recommended interventions included fixed‐dose combination drugs, once‐daily or once‐weekly dosing schedules, unit‐dose packaging, educational counselling by telephone, case management by pharmacists, treatment in pharmacist‐ or nurse‐operated disease management clinics, mailed refill reminders, self‐monitoring, dose‐tailoring, rewards and various combination strategies. Personalised, patient‐focused programs that involved frequent contact with health professionals or a combination of interventions were the most effective at improving compliance. Less‐intensive strategies, such as prescribing products that simplify the medication regimen or sending refill reminders, achieved smaller improvements in compliance but may be cost‐effective due to their low cost.