Don't Forget To Take Your Medicine

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Adherence to medical treatment is not always an easy task. And while the Holy Grail leading to high adherence rates has yet to be found, financial incentives and the ubiquitous smartphones are frequently in the running as solutions. In this week JAMA Internal Medicine, Medication Reminders to Improve Outcomes After Myocardial Infarction should give us pause in this quest.

In the study, 1509 patients with a diagnosis of acute myocardial infarction taking at least two of four standard medications for patients with this diagnosis were randomized to the treatment arm or control. The treatment included financial incentives, electronic pill bottles and social support aimed at increasing medication compliance. The pill bottles notified family or friends if not used in 2 out of the three last days; a daily lottery for those adherent for drug use had a 20% chance of a $5 payout and a 1% chance of a $50 payout.

  • There was no difference in time to first readmission or death
  • There was no difference in healthcare dollars spent
  • There was no difference in adherence to medications (measured by drug refills)

Because adherence was measured by refills and the study had no information regarding when the prescription had been written, three varying definitions of compliance were applied. But even under the most relaxed of circumstances (adherence measured from the time of first filling of prescription) compliance with all three medications (a statin, beta-blocker and anti-platelet medication) was 63%. That is a low number. While other studies have suggested that reminder systems can increase compliance, this study did not. And before you write this off to a case of personal responsibility, try and take 3 or more pills a day for a long time.