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The Pharmaceutical Journal Vol 272 No 7284 p119 31 January 2004	This article Reprint Photocopy
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Letters to the Editor

Compliance

Compliance in primary care may be affected by hospital prescribing

From Ms E. J. Hawes, MRPharmS

Have the authors of “Compliance with statins in primary care” (PJ, 3/10 January, p23 (PDF 85K)) considered hospital admission among the limitations of their study. Most patients who are in hospital for more than a few days will have been supplied with some medicines from the hospital pharmacy and this may reduce the supplies collected from a community pharmacy. This could amount to two months’ treatment in some cases but many patients admitted for shorter periods will have received a 28-day supply. It may therefore be that some of these “non-compliant” patients may have been over 80 per cent compliant. A proportion of these people will have been admitted for cardiovascular problems and hence they are likely to have a greater coronary heart disease mortality but they may be over-represented in the “non-compliant” group.

Jane Hawes
Didsbury, Manchester

DAVID MOTTRAM replies:

Acknowledging that there are inherent limitations, some of which were highlighted in the paper, the method for assessing compliance, within this study, is widely accepted. The particular limitation referred to by Ms Hawes was not considered by us to have had a major impact on the results of the study for a number of reasons. The catchment hospital for the majority of these patients employs a “patients’ own drugs” system, where the patient brings in the majority of their repeat medicines. Even for those patients who did not take their own medicines into hospital the impact upon the compliant and non-compliant groups would be similar and would even itself out in the long run. Many patients order their repeat prescription on the same date of each month, irrespective of how many tablets they have at home. The average length of stay for unstable angina and myocardial infarction patients is seven to 10 days rather than two months.

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