EXECUTIVE SUMMARY

Periodic Survey #44

Patient Compliance With Prescription Regimens

This report presents findings from Periodic Survey #44 covering pediatricians' views on patients' compliance with completing prescription regimens for acute and chronic illness. The survey was initiated by the Committee on Practice and Ambulatory Medicine (COPAM) and supported by the Committee on Drugs (COD) to explore the scope of the problem, strategies used to improve patient compliance, barriers to completing prescription regimens, and pediatricians' interest in further education in this area. These data were collected to help identify areas of need for the development of educational resources to enhance pediatricians' ability to ensure patient compliance with prescribed medication regimens.

The survey was conducted from January to May 2000; after six mailings a total of 925 completed questionnaires were received for a response rate of 56.7%. These analyses are based on responses from 803 pediatricians who provide direct patient care.

Views on Medication Compliance

� Pediatricians report seeing an average of 92 patients during a typical workweek and writing prescriptions for an average of 53% of those patients.

� Among prescriptions written in an average workweek, approximately 73% are for short-term, acute illnesses and 29% are for chronic long-term illnesses.

� More than three-fourths of pediatricians say they always verbally communicate medical information regarding a prescription regimen to patients and parents: 78% address age-appropriate patients and 81% communicate the information to parents. About one-fourth of pediatricians say they always distribute such information in writing.

� About 8% of pediatricians say their patients usually fail to take medications as prescribed; about one-fourth say this occurs often and 40% report such failure occurs occasionally. Only about 20% say their patients seldom or never fail to take medications as prescribed.

� Nearly half of pediatricians (48.6%) report they routinely document the failure of patients with acute illness to take medications as prescribed; 58.9% of pediatricians routinely document the lack of compliance among chronically ill patients. Thirty-seven percent and 29.4% of pediatricians occasionally document lack of compliance among patients with acute illness and chronic illness, respectively.

� Nearly all pediatricians (89.9%) agree that lack of compliance with a prescription regimen interferes with the ability to control a medical condition; however, they are slightly less certain about the effect on recovery from an illness (78.2% agree lack of compliance affects patients' recovery from an illness).

Strategies Used to Improve Patient Compliance

� Nine out of ten pediatricians say they inquire about patient's preferred medication form or flavor before prescribing (89.7%) and they use manufacturers' medication innovations such as once daily dosing, quick dissolve tablets or sprinkles in capsules to place in food (89.1%) to encourage compliance with a prescription regimen. Other strategies named by a majority of pediatricians include encouraging parents to use sweeteners or mix medications with other foods (85.0% reporting) and giving patients a medication instruction sheet (73.1%).

� No single strategy to improve patient compliance was considered to be "very effective" by a majority of pediatricians. Most pediatricians thought most strategies are only "somewhat" effective.

Barriers to Following a Prescription Regimen

Overall, a similar proportion of pediatricians agree on barriers to following a prescription regimen for acute illness and for chronic illness; however, the order in which the barriers are named varies somewhat for each type of illness.

� Barriers that impact compliance for patients with acute illness include: frequency of dosing schedule (96.0% of pediatricians reporting), unpleasant taste of medication (90.8%), side effects of medication (88.3%), duration of dosing schedule (86.8%), unpleasant palatability (86.7%) and parental perception of medication effectiveness (85.6%).

� Barriers that impact compliance for patients with chronic illness include: frequency of dosing schedule (91.1% of pediatricians reporting), parental perception of medication effectiveness (88.6%), side effects of medications (88.0%), unpleasant taste of medication (83.9%), lack of continuity in adult supervision of prescription regimen (83.0%), unpleasant palatability (80.9%).

Interest in Education on Medication Compliance

� Twenty-three percent of pediatricians are very interested in receiving further education that focuses on issues in medication compliance; 50.2% are somewhat interested.

� The most frequently named ways in which pediatricians would like to receive such education are by AAP self-instructional material such as PREP or PIR (53.2% reporting), written materials (53.2%) and journal articles (48.1%).

� Among pediatricians who prefer to receive medication compliance education from the AAP via regular CME courses (26.8%) or CME at the Annual (22.5%) or Spring meetings (16.4%), the largest proportion (40%) prefer the lecture and Q & A method, while 29% prefer straight lectures.