Researchers fight America's 'other drug problem'

November 17, 2010, University of Missouri-Columbia
The graph depicts a patient’s medication-taking habits: the scattered dots illustrate irregular adherence (before the intervention), followed by consistent dots that depict improved adherence immediately after beginning the Continuous Self-Improvement strategy. Credit: MU

Medications do not have a chance to fight health problems if they are taken improperly or not taken at all. Non-adherence to medications costs thousands of lives and billions of dollars each year in the United States alone, according to the New England Healthcare Institute. Now, researchers at the University of Missouri have developed an intervention strategy that is three times more effective than previously studied techniques at improving adherence in patients.

Cynthia Russell, associate professor in the MU Sinclair School of Nursing, found that patients who used a Continuous Self-Improvement strategy drastically improved their . The strategy focuses on counseling patients to understand how taking medications can fit into their daily routines. Nurses meet with patients and discuss their daily schedules to identify optimal times to take medications and safe places to store their medications.

"Continuous Self-Improvement is a personalized strategy, and the scheduling is different for every patient," Russell said. "Finding the right place and time for patients to take medications can be as simple as storing the pill bottles in their cars so their medication will be available for them to take during the morning commute to work."

In the study, kidney transplant patients were given pill bottles with caps that automatically recorded the date and time whenever they were opened. Each month, a nurse reviewed the results in illustrated reports with the patients and discussed how they could improve their adherence. The researchers found significant improvements among patients' adherence rates. The results indicate the technique is three times more effective than previously studied techniques.

Russell recommends that patients meet with nurses to implement the strategy a few months after procedures, when they have returned to their normal routines. During follow-up appointments, patients can discuss potential problems and strategies for taking their medications.

"Ideally, all patients should use electronic monitoring pill bottles because it enables them to see computerized graphs of their previous month's medication schedules and medication taking," Russell said. "We found that patients enjoyed seeing their results at each meeting and were interested in receiving the feedback."

An estimated 35 percent of kidney transplant patients do not take their medications daily and 75 percent do not take their medications at the correct times. It is important for transplant to take medications correctly because incorrect dosages could result in side-effects, rejection of the organs or death.

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