Arch Intern Med 26 Mar 2007

We dole them out, but 20-50% of the pills we prescribe remain on the shelf. This systematic review of interventions to enhance medication adherence in chronic medical conditions finds 37 eligible trials, which show that a number of different interventions can improve adherence, but none definitely improve clinical outcomes.
In UK primary care, we have been shoved towards a chronic care model for the management of chronic obstructive pulmonary disease, and I can’t help feeling this must be a good thing, even though the only intervention which makes much difference is smoking cessation. What does a systematic review show? As usual, that there is a need for further well-designed trials: those that have been done show fewer hospital admissions with managed care, but no differences in function or mortality.
Nearly 80,000 nurses contributed information on health and medication to the Nurses’ Health Study from 1980 onwards. The ones who took aspirin showed a reduction in cardiovascular death after 5 years and a reduction in cancer death after 10 years. Does this amount to proof that all women over a certain age should take low-dose aspirin? Not quite, but it’s beginning to look that way.
African Americans have higher rates of cardiovascular disease (and die on average five years younger) than white Americans.  Do we know why? Actually, we do: 90% of their events are explicable on the basis of known major risk factors, compared with only 65% in white subjects. We need a similar study in the UK Afro-Caribbean population.