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#44: Improving patient adherence to medication with Dr Eric Peterson

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Patient adherence to medication has long defied quantification, with many physicians assuming that the cost of medications is the primary factor explaining poor rates of compliance. The MI FREEE trial conducted by Dr Niteesh Choudry, and presented during AHA 2011 offers stunning proof that compliance is a more complicated issue than cost alone and raises numerous issues that our guest Dr Eric Peterson discusses. How do we explain abysmal rates of patient adherence to medication? Should the physician be held responsible for adherence?

See:

Cutting copays for post-MI drugs helps outcomes, with no added cost to insurers

Choudhry N, Avorn J, Glynn R, et al. The impact of full coverage for preventative medications after myocardial infarction on recurrent vascular events and health spending: The post-myocardial infarction free Rx event and economic evaluation (MI FREEE) trial. N Engl J Med 2011; DOI: 10.1056/NEJMsa110793. Available at: http://www.nejm.org

Aetna. Aetna launching value-based program that improves medication adherence, cost and outcomes for members who have suffered from heart attacks [press release]. November 14, 2011. Available here.

Goldman L and Epstein AM. Improving adherence—money isn't the only thing. N Engl J Med 2011; DOI:10.1056/nejme1111558. Available at: http://www.nejm.org.

Dr Peterson has received grants for clinical research from Bristol-Myers Squibb, Eli Lilly, Johnson & Johnson, and Sanofi-Aventis

For Dr Harrington's disclosures, click here.

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I don't know about being held responsible but it seems that it is part of the job to encourage compliance with medication. Isn't the objection to low carbohydrate diets that people won't stick with them (despite data in the literature that they have better adherence than other diets)? In lipid markers, metabolic syndrome and diabetes, diet can frequently give better results than drugs. Shouldn't physicians be trained in getting compliance.  Along which lines, isn't the continued use of intention-to-treat analysis inappropriate since efficacy and adherence may be under the conrol of different variables?
Posted by Richard David Feinman, Feb 20, 2012 at 07:37 AM, EDT
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About The Bob Harrington Show
In his series of discussions, Bob Harrington provides valuable context to news and topics in cardiology by seeking the counsel of thought leaders at the heart of the event. New episodes are published on a monthly basis and are available on both theheart.org and iTunes.
About Robert A Harrington MD
Dr Harrington is the director of the Duke Clinical Research Institute (DCRI) and professor of medicine at Duke University Medical Center, where he practices interventional cardiology.

Dr Harrington's research interests include evaluating antithrombotic therapies to treat acute ischemic heart disease and minimize the acute complications of percutaneous coronary procedures, studying the mechanism of disease of acute coronary syndromes, understanding the issues of risk stratification in the care of patients with acute ischemic coronary syndromes, and trying to better understand and improve upon the methodology of clinical trials.

Author of multiple peer-reviewed manuscripts, reviews, book chapters, and editorials, he was one of the senior coeditors for the 8th edition of the American College of Chest Physicians' Consensus Panel on Antithrombotic and Thrombolytic Drugs. Dr Harrington is an associate editor of the American Heart Journal and an editorial board member for the Journal of the American College of Cardiology. He is a fellow of the ACC, AHA, SCAI, ACCP, and ESC and is a member of the board of trustees of the ACC. He recently served as chair of the FDA Cardiovascular and Renal Drugs Advisory Committee.

When not focusing on acute coronary syndromes, Dr Harrington dreams of being a radio commentator for the Boston Red Sox.