What does this research mean for the field?

Medication compliance measured by pill counts exhibits marked intersubject and intrasubject variability that is obscured by long-term averages, with excessive pill counts likely reflecting 'pill dumping' rather than true hypercompliance. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To prospectively evaluate medication compliance patterns and variability over time in hypertensive patients using surreptitious pill counts.

August 1, 1989Clinical Pharmacology & Therapeutics

The natural history of medication compliance in a drug trial: Limitations of pill counts

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Population

121 middle-aged ambulatory hypertensive subjects selected for high rates of compliance

Design

Cohort

Follow-up

≤12 months

Authors

PRPeter RuddRoyal Devon & Exeter NHS Foundation Trust RBRichard L. ByynyUniversity of Southern California VZValerie ZacharyStanford Medicine

Discussion

Member takes

Implication

Caution against relying on averaged pill counts for adherence; leaves open validity of compliance metrics in hypertension cohorts.

Key Points

To prospectively evaluate medication compliance patterns and variability over time in hypertensive patients using surreptitious pill counts.
Conducted prospective, surreptitious pill counts every 1 to 12 weeks for up to 12 months in N=121 ambulatory hypertensive subjects selected for high baseline compliance.
Assessed regimens consisting of pinacidil or hydralazine taken four times daily alongside secondary antihypertensive medications taken up to twice daily.
Mean overall compliance approached 100%, yet marked intersubject and intrasubject variability occurred across different medications and intervals.
Subsequent mean blood pressures did not significantly differ among compliance categories (systolic: F1,52 = -220.9, NS; diastolic: F1,52 = -121.4, NS), averaging 151.3/91.0 mm Hg in hypocompliers (<80%), 147.6/91.4 mm Hg in hypercompliers (≥120%), and 143.3/88.5 mm Hg in eucompliers (80% to 119%).
Lapses in medication adherence occurred randomly over time, and excessive pill counts in hypercompliers were most consistent with intentional pill dumping before visits.

Structured PICO

Population

121 middle-aged ambulatory hypertensive subjects selected for high rates of compliance

Intervention

Pinacidil or hydralazine administered four times a day and secondary drugs administered up to twice daily, monitored via surreptitious pill counts every 1 to 12 weeks

Outcome

Medication compliance rates and subsequent blood pressure

Pill counts to assess medication compliance show marked variability that is obscured by long-term averages, and excessive pill-taking may indicate 'pill dumping'.

Cite This Study

Rudd et al. (1989) studied this question.

synapsesocial.com/papers/6a189d3a70dbaace42cf7db9 https://doi.org/10.1038/clpt.1989.122

Topics

Hypertension management

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The natural history of medication compliance in a drug trial: Limitations of pill counts

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

The natural history of medication compliance in a drug trial: Limitations of pill counts

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider