Detection methods and strategies for improving medication compliance

The reliability of compliance detection methods and practical strategies for improving patient compliance with drug therapy are reviewed. Detection of noncompliance is a necessary prerequisite for adequate treatment. Noncompliance can be detected by indirect methods (e.g., self-report, interview, therapeutic outcome, pill count, computerized compliance monitors) or direct methods (e.g., biologic markers, tracer compounds, biologic assay of body fluids). In general, the direct methods of detection have a higher sensitivity and specificity than the indirect methods. Computerized compliance monitors are the most recent and reliable of the indirect-detection methods. Strategies for improving compliance involve identification of risk factors for non-compliance; development, with the patient's participation, of an individualized treatment plan that simplifies the regimen as much as possible; education of the patient, including information about his or her illness, instructions on how to take the prescribed medication correctly, and an explanation of the benefits and possible adverse effects of the therapy; and, if necessary, use of compliance aids such as medication calendars, special containers, caps, and dispensing systems, or compliance packaging. The patient should be taught to monitor his or her own treatment regimen. Follow-up monitoring by health-care professionals, including pharmacists, will also help ensure that the patient is complying with the treatment regimen. Health-care practitioners need to understand factors that contribute to noncompliance and to use effective methods for assessing and monitoring compliance in conjunction with strategies aimed at increasing compliant behavior.