Original Communication

Am J Hypertens (1996) 9, 719–725; doi: 0895-7061(96)00056-8

Assessing medication adherence by pill count and electronic monitoring in the African American Study of Kidney Disease and hypertension (AASK) pilot study*

Jeannette Y. Lee1, John W. Kusek2, Paul G. Greene1, Steve Bernhard1, Keith Norris3, Delia Smith1, Beth Wilkening4 and Jackson T. Wright5 for the AASK Pilot Study Investigators

  1. 1University of Alabama at Birmingham, Birmingham, Alabama, USA
  2. 2National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland, USA
  3. 3Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
  4. 4Emory University, Atlanta, Georgia, USA
  5. 5Case Western Reserve University, Cleveland, Ohio, USA

Correspondence: Jeannette Y. Lee, PhD, Research Associate Professor of Medicine, Biostatistics Unit, Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294-3300.

*This article was supported by the National Institute of Diabetes, Digestive and Kidney Diseases through cooperative agreements: U01 DK45431, U01 DK45381, U01 DK45373, U01 DK45430, U01 DK45426, U01 DK45388, and U01 DK45387.

The following pharmaceutical companies donated antihypertensive drugs for the study: Merck Research Laboratories (enalapril), Pfizer, Inc. (amlodipine and doxazosin), and ICI Zeneca (atenolol),

The pilot study investigators and institutions are listed in the appendix.

Received 2 June 1995; Revised  0000; Accepted 23 January 1996.

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Abstract

The Medication Event Monitoring System (MEMS), an electronic monitor which records the date and time of bottle cap openings, and pill counts were used to assess patterns of adherence for the primary antihypertensive drug in the African American Study of Kidney Disease and Hypertension Pilot Study (AASK). Blacks with hypertension and moderately reduced renal function were randomized to one of two levels of blood pressure control and to one of three antihypertensive drug regimens: primary therapy with a calcium channel blocker, an angiotensin converting enzyme inhibitor, or a beta-blocker.

On the 94 participants in AASK, 91 had MEMS recordings and pill counts for 313 regularly scheduled monthly follow-up visits. The average length of follow-up was 4.6 months. An acceptable level of adherence by pill count was achieved if 80% to 100% of the prescribed pills were not returned to the clinic. Adherence by MEMS to a once-a-day drug dosing schedule was acceptable if 80% of the time intervals between MEMS openings were within 24 plusminus 6 h. Acceptable adherence by pill count was observed at 68% of the follow-up visits; MEMS indicated nonadherence at 47% of those visits. Blood pressure was within goal in 50% of the participants who were adherent by both pill count and MEMS throughout their follow-up visits, and only 14% of the participants who were identified nonadherent by one or both methods. These findings suggest that electronic monitoring is a useful adjunct to pill counts in assessing adherence to antihypertensive drugs. Feedback of electronically collected information on dosing intervals to participants and staff may enhance adherence.

Keywords:

Compliance, antihypertensive drugs, Medication Event Monitoring System (MEMS)

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References

  1. Rudd, P., Ahmed, S., Zachary, V., et al. (1992). Issues in patient compliance: the search for therapeutic sufficiency. Cardiology. 80(suppl 1): 2–10.
  2. Horwitz, R. I., Viscoli, C. M., Berkman, L., et al. (1990). Treatment adherence and risk of death after a myocardial infarction. Lancet. 336: 542–545. | Article | PubMed | ChemPort |
  3. Gallagher, E. J., Viscoli, C. M. and Horwitz, R. I. (1993). The relationship of treatment adherence to the risk of death after myocardial infarction in women. JAMA. 270(6): 742–744.
  4. Coronary Drug Project Research Group (1980). Influence of adherence to treatment and response of cholesterol on mortality in the Coronary Drug Project. N Engl J Med. 303: 1038–1041.
  5. Pullar, T., Kumar, S. and Feely, M. (1989). Compliance in clinical trials. Ann Rheum Dis. 48: 871–875.
  6. Cramer, J. A., Mattson, R. H., Prevey, M. L., et al. (1989). How often is medication taken as prescribed? JAMA. 261: 3273–3277. | Article | PubMed | ISI | ChemPort |
  7. Rudd, P. and Marshall, G. (1987). Resolving problems of measuring compliance with medication monitors. Journal of Compliance in Health Care. 2(1): 23–35.
  8. Rudd, P., Byyny, R. L., Zachary, V., et al. (1989). The natural history of medication compliance in a drug trial: limitations of pill counts. Clin Pharmacol Ther. 46(2): 169–176. | PubMed | ChemPort |
  9. Pullar, T., Birtwell, A. J., Wiles, P. G., et al. (1988). Use of a pharmacologic indicator to compare compliance with tablets prescribed to be taken once,twice, or three times daily. Clin Pharmacol Ther. 44(5): 540–545.
  10. Pullar, T. and Feely, M. (1990). Problems of compliance with drug treatment: new solutions? Pharm J. 245: 213–215.
  11. Rand, C. S., Wise, R. A., Nides, M., et al. (1992). Metered-dose inhaler adherance in a clinical trial. Am Rev Respir Dis. 146: 1559–1564.
  12. Rudd, P., Ramesh, J., Bryant-Kosling, C. and Guerrero, D. (1993). Gaps in cardiovascular medication taking: the tip of the iceberg. J Gen Intern Med. 8: 656–666.
  13. Stephenson, B. J., Rowe, B. H., Haynes, R. B., et al. (1993). Is this patient taking the treatment as prescribed? JAMA. 269(21): 2779–2781. | Article | PubMed |
  14. Pullar, T., Kumar, S., Tindall, H. and Feely, M. (1989). Time to stop counting tablets? Clin Pharmacol Ther. 46(2): 163–168. | PubMed | ChemPort |
  15. Cramer, J. A., Schever, R. D. and Mattson, R. H. (1990). Compliance declines between clinic visits. Arch Internal Med. 150: 1509–1510.
  16. Bond, W. S. and Hussar, D. A. (1991). Detection methods and strategies for improving medication compliance. Am J Hosp Pharm. 48: 1978–1988. | PubMed | ChemPort |
  17. Clark, L. T. (1991). Improving compliance and increasing control of hypertension: needs of special hypertensive populations. Am Heart J. 121: 664–669. | Article | PubMed | ISI | ChemPort |
  18. Shea, S., Misra, D., Ehrlich, M. H., et al. (1992). Correlates of non-adherence to hypertension treatment in an inner-city minority population. Am J Public Health. 82(12): 1607–1612.
  19. Furberg, C. D. and Black, D. M., SHEP Research Group (1988). The systolic hypertension in the elderly pilot program: methodological issues. Eur Heart J. 9: 223–227.
  20. Shulman, N., Cutter, G., Daugherty, R., et al. (1982). Correlates of attendance and compliance in the Hypertension Detection and Follow-up Program. Controlled Clin Trials. 3: 13–27.
  21. Connett, J. E. and Stamler, J. (1984). Responses of black and white males to the special intervention program of the Multiple Risk Factor Intervention Trial. Am Heart J. 108: 839–849.
  22. Wright, J. T., Jr., Kirk, K. A., Kusek, J. W., et al. (1994). Design of the African-American Study of Kidney Disease and Hypertension (AASK) Pilot Study (abst). J Am Soc Nephrol. 5(3): 570.
  23. Lee, J. Y., Greene, P. G., Douglas, M., et al. Appointment attendance, pill counts, and achievement of target blood pressure in the African American Study of Kidney Disease and Hypertension. Controlled Clin Trials. (in press).
  24. Whelton, P., Lee, J. and Kopple, J., et al., for the AASK Pilot Investigators (1994). Recruitment in the African American Study of Kidney Disease and Hypertension (AASK) (abst). J Am Soc Nephrol. 5(3): 570.
  25. Breyer, J. A., Toto, R. D. and Hall, W. D., et al., for the AASK Pilot Investigators (1994). Baseline characteristics of patients entering the pilot African-American Study of Kidney Disease (Pilot-AASK) (abst). J Am Soc Nephrol. 5(3): 557.
  26. Rudd, P., Ahmed, S., Zachary, V., et al. (1990). Improved compliance measures: applications in an ambulatory hypertensive drug trial. Clin Pharmacol Ther. 48: 679–685.
  27. Fleiss, J. L. (1981). Statistical Methods for Rates and Proportions, 2nd Ed. John Wiley & Sons: New York.
  28. Treatment of Mild Hypertension Study Group (1991). The Treatment of Mild Hypertension Study. Arch Intern Med. 151: 1413–1423. | ISI |
  29. Eisen, S. A., Woodward, R. S., Miller, D., et al. (1987). The effect of medication compliance on the control of hypertension. J Gen Intern Med. 2: 298–305. | PubMed | ChemPort |
  30. Guerrero, D., Rudd, P., Bryant-Kosling, C. and Middleton, B. F. (1993). Antihypertensive medication-taking. Am J Hypertens. 6: 586–592. | PubMed | ChemPort |
  31. Nides, M. A., Tashkin, D. P., Simmons, M. S., et al. (1993). Improving inhaler adherence in a clinical trial through the use of the nebulizer chronolog. Chest. 104(2): 501–507.
  32. McKenney, J. M., Munroe, W. P. and Wright, J. T., Jr. (1992). Impact of an electronic medication compliance aid on long-term blood pressure control. J Clin Pharmacol. 32: 277–283.
  33. Lazarus, J. M., Bourgoignie, J. J. and Buckalev, V. M., et al, for the Modification of Diet in Renal Disease Study Group. Achievement of blood pressure goals and safety of the blood pressure interventions in the Modification of Diet in Renal Disease Study. (Submitted).

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