Phone Counseling Fails to Improve Bisphosphonate Adherence

February 28, 2012

By Frederik Joelving

NEW YORK (Reuters Health) Feb 27 - People with osteoporosis often skip the drugs they are prescribed, and telephone counseling does little to change that, according to new research.

For people at high risk, drugs such as bisphosphonates may cut the yearly fracture risk from 5% to 3%, said Dr. Daniel Solomon of Brigham and Women's Hospital in Boston.

But people often stop taking the medications, he said.

"It's the problem with all chronic conditions," Dr. Solomon told Reuters Health. "Drugs for asymptomatic chronic conditions are universally poorly adhered to."

Some 10 million Americans currently suffer from bone thinning, according to the National Osteoporosis Foundation. The majority are postmenopausal women.

Bone drugs include Merck's Fosamax, Roche's Boniva, Novartis's Reclast and Warner Chilcott's Actonel.

To see if they could convince people to take their drugs, Dr. Solomon and his colleagues recruited more than 2,000 patients with osteoporosis (mean age, 78; 94% women) and randomly divided them into two groups.

The participants were all members of a Medicare pharmacy benefits group; they got their meds for a co-pay of no more than a few dollars. All of them received fall-prevention lifestyle tips in the mail from the researchers, and one group also had about eight counseling sessions over the phone, over the course of a year.

During those sessions, trained counselors tried to identify why people might have skipped their drugs and to motivate them to get back on the treatment. The intervention ended up costing about $281 per patient, including training of the counselors.

At the end of the year, there was little difference between the two groups.

Those who got counseling filled their prescriptions 49% of the time, while the others did so 41% of the time, based on claims data. That difference was not statistically significant.

The researchers didn't find any differences in rates of fractures or falls, either.

According to Dr. Solomon, whose findings were released online today in the Archives of Internal Medicine, people who skipped their medicine often said they had forgotten about it, didn't like the way it made them feel or didn't think they needed it.

Still, he isn't willing to give up on counseling.

"It would be overstating the data to say that we should use this. What I'm saying is you don't want to throw the baby out with the bathwater," he said. "I think that counseling is something we need to continue to examine."

Researchers have been experimenting with a lot of ways to get people to take their drugs, including beeping pill caps and financial incentives, Dr. Solomon added. But the results have often been disappointing.

"At this point there really aren't any proven interventions," he said.

In an editorial, Dr. Seth Berkowitz and Dr. Kirsten Johansen of the University of California, San Francisco, say behavior change is an increasingly important part of medicine as chronic diseases continue rise.

"There is likely no 'magic bullet' in the behavior change arsenal in general or for increasing treatment adherence specifically," they write. "This does not mean, however, that the effects may not be clinically significant."


Arch Intern Med 2012.


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