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Australian Journal of Pharmacy : May 2008
Drug month of the Zanidip Does improved compliance lead to better health outcomes? optimal benefits from their medicines, and this is especially so for people with hypertension—an essentially symptomless disease. Patients on antihypertensives (AHTs) must take their medication on a long-term basis. Since adverse effects contribute to poor compliance, any measure that improves tolerability will increase compliance. Improved compliance generally translates into better patient health outcomes. P Benefits of BP-lowering are not reaching patients Reduction in blood pressure through antihypertensive drugs is associated with significant decrease in cardiovascular disease morbidity and mortality.1 However, a comprehensive review of the impact of antihypertensive treatment reports that nearly 75% of patients worldwide do not achieve a satisfactory BP, according to guidelines.2 Analysis of cardiovascular disease outcomes in the Second Australian National Blood Pressure Study show a 20-23% higher event rate in patients with poor medication compliance.3 US data supports the link between poor persistence and worse health outcomes.4 This indicates that, unless compliance can be improved, the actual benefits of drug treatments are likely to be less than predicted, with a persistently elevated morbidity and mortality and increased healthcare costs associated with hypertension. Leveraging your professional strengths • Pharmacist-based compliance strategies are crucial to improving patient outcomes. Therefore, programs such as the recently launched compliance indicator software MedsIndex, developed by the Pharmacy Guild of Australia can be used to assess individual patient behaviour over time. • The National Prescribing Service (NPS) encourages routine checks of adherence. ‘Optimise adherence with medication and lifestyle review at every opportunity’. NPS Prescribing Practice Review No.38 (July 2007). • Targeted intervention strategies should be deployed if a patient is at risk of Influence of drug class It is already known that persistence among different AHT drug classes varies, with ACEIs and A2RAs showing best persistence. Two recent publications2,5 confirm this, but also show differences within drug classes. Of the calcium non-compliance and all patients should be proactively reminded to collect their first repeat. When their last repeat is dispensed patients should be reminded to return to their GP. • Those with a gap of more than 30 days should be reminded about the benefits of persisting with treatment and also the risks they expose themselves to by failing to take their medication. channel blockers (CCBs), Zanidip (lercanidipine) demonstrates significantly higher persistence compared to other CCBs, and a possible explanation for this is better tolerability. Simons et al, analysed persistence using Medicare Australia data (between 2004 and 2006) for the most common AHT drugs: A2RAs, ACEIs and CCBs. Analysis of PBS claims was limited to prescriptions of long-term concession card holders, estimated to represent 65% of all patients receiving AHT drug.5 Key points from the study were that: • Patients with significant issues or adverse events should be referred back to their GP. • QUM in antihypertensive therapy is also good for business. A compliant patient will develop a trusted relationship with their pharmacist providing opportunities for increased dialogue and intervention on other health issues, such as smoking cessation, diabetes and weight loss. oor patient compliance has been identified as a common reason for patients failing to achieve The AusTrAliAn journAl of PhArmAcy vol.89 mAy 2008 48 advertorial