A critical review of interventions to improve compliance with prescribed medications

Research during the last 10 years has given us considerable insight into the nature of the problem of patient non-compliance with prescribed medical regimens and has validated a number of strategies that enhance compliance. Using the results of only the very best designed and executed studies, several interventions merit incorporation into clinical practice.Compliance with short-term treatments (less than 2 weeks) can be improved by clear instructions; by parenteral dosage forms; by special ‘reminder’ pill containers and calendars; and by simplified drug regimens.Compliance with long-term treatments is more difficult to achieve: no single intervention has been shown to be useful on its own to date. Rather, enhancing long-term compliance requires combinations of the following: clear instructions; recalling non-attenders; patient self-monitoring of compliance and/or treatment outcomes; enhancement of social support; ‘contingency contracting’ and rewards or reinforcement for high compliance; and group discussion and supervised self-management. None of these interventions is self-sustaining: they must continue to be applied as long as compliance is required.The pace of compliance research has slowed in the last few years but much work remains to be done.