Common sense tells us that the more pills a patient takes, the more likely they are to forget or not follow a treatment regimen as prescribed. There is no doubt in reviewing the literature that this has been proven. For my personal knowledge, I wanted to know the answer to the question, do combination pills improve adherence, and by how much?
In one study by Lauffenburger et al, “Patients who initiated fixed-dose combinations had higher rates of adherence than those initiating a single drug (51.3% vs. 42.1%). After multivariable adjustment, patients initiating fixed-dose combinations were 9% more likely to be persistent (length of time patients stick with drug therapy) with anti-hypertensive treatment (relative risk [RR]: 1.09, 95% CI: 1.08–1.10) and 13% more likely to be adherent (RR: 1.13 95% CI: 1.11–1.14) than patients initiating single-drug therapy (Table 3). Refill rates were also slightly higher among fixed-dose combination initiators.”
Do combination pills improve adherence? The evidence is clear to me that this is a better option for the patient with all other things being equal. While I mostly work in Assisted Living and LTC settings at this point in my career, I think it is critical to utilize combination medications whenever possible. If you had an intervention that improved adherence by 10% and didn’t impact patient outcomes in any other way, you’d definitely incorporate that into your practice.
I’d encourage my ambulatory care friends who work with patients with respiratory diseases, hypertension, and other conditions where combinations are available to be deliberate in which medications they initiate. I also acknowledge that insurance formularies may not be friendly to this approach in certain situations.
Being able to recognize which medications you will be able to combine with other medications in one-pill or one-dose formulations is critical down the road if you need to add another medication to a patient’s drug regimen.
Are you as good as you should be about recommending or prescribing combination pills?
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