They began the program in 2004, and nearly 70,000 patients agreed to participate. The team monitored compliance for two years by checking on whether and how often patients refilled their prescriptions, then monitored health effects in the third year through the patients' health records.
Some 47,268 patients had what the team termed "low exposure" to the drugs, taking them less than half the time. Their risk of hospitalization for heart attack or stroke was lowered by 15 events per 1,000 person-years, and an estimated 726 events were prevented.
An additional 21,292 patients had "high exposure" to the drugs, taking them more than half the time. Their risk was reduced by 26 events per 1,000 person-years, preventing an estimated 545 events.
"What was fairly amazing to me was that we got such a good drop in heart attack and strokes despite the low adherence," Dudl says.
"The issue now is how to increase adherence.''
The primary reasons for non-adherence, he notes, were things such as, "I don't know why I was taking the drugs," "I forgot to refill the prescription," and "I worry about side effects."
Those are issues "that have to be addressed with each patient, one by one." Kaiser now has a follow-up program focused on adherence, he says.
"We made it the simplest regimen we could," he adds, with a standardised dose of each drug for everyone.
"Can you imagine how difficult it would have been if it were a more complicated regimen or physicians had to schedule multiple visits to adjust dosages for each patient. It's a great example of how difficult it is for people to understand and do something that is beneficial to them."
