Compliance assessment of ambulatory Alzheimer patients to aid therapeutic decisions by healthcare professionalsReport as inadecuate

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BMC Health Services Research

, 10:232

First Online: 09 August 2010Received: 18 October 2009Accepted: 09 August 2010DOI: 10.1186-1472-6963-10-232

Cite this article as: Schwalbe, O., Scheerans, C., Freiberg, I. et al. BMC Health Serv Res 2010 10: 232. doi:10.1186-1472-6963-10-232


BackgroundCompliance represents a major determinant for the effectiveness of pharmacotherapy. Compliance reports summarising electronically compiled compliance data qualify healthcare needs and can be utilised as part of a compliance enhancing intervention. Nevertheless, evidence-based information on a sufficient level of compliance is scarce complicating the interpretation of compliance reports. The purpose of our pilot study was to determine the compliance of ambulatory Alzheimer patients to antidementia drugs under routine therapeutic use using electronic monitoring. In addition, the forgiveness of donepezil i.e. its ability to sustain adequate pharmacological response despite suboptimal compliance was characterised and evidence-based guidance for the interpretation of compliance reports was intended to be developed.

MethodsWe determined the compliance of four different antidementia drugs by electronic monitoring in 31 patients over six months. All patients were recruited from the gerontopsychiatric clinic of a university hospital as part of a pilot study. The so called medication event monitoring system MEMS was employed, consisting of a vial with a microprocessor in the lid which records the time date, hour, minute of every opening. Daily compliance served as primary outcome measure, defined as percentage of days with correctly administered doses of medication. In addition, pharmacokinetics and pharmacodynamics of donepezil were simulated to systematically assess therapeutic undersupply also incorporating study compliance patterns. Statistical analyses were performed with SPSS and Microsoft Excel.

ResultsMedian daily compliance was 94% range 48%-99%. Ten patients 32% were non-compliant at least for one month. One-sixth of patients taking donepezil displayed periods of therapeutic undersupply. For 10 mg and 5 mg donepezil once-daily dosing, the estimated forgiveness of donepezil was 80% and 90% daily compliance or two and one dosage omissions at steady state, respectively. Based on the simulation findings we developed rules for the evidence-based interpretation of donepezil compliance reports.

ConclusionsCompliance in ambulatory Alzheimer patients was for the first time assessed under routine conditions using electronic monitoring: On average compliance was relatively high but variable between patients. The approach of pharmacokinetic-pharmacodynamic in silico simulations was suitable to characterise the forgiveness of donepezil suggesting evidence-based recommendations for the interpretation of compliance reports.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-10-232 contains supplementary material, which is available to authorized users.

Oliver Schwalbe, Christian Scheerans and Charlotte Kloft contributed equally to this work.

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Author: Oliver Schwalbe - Christian Scheerans - Ines Freiberg - Andrea Schmidt-Pokrzywniak - Andreas Stang - Charlotte Kloft



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