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Marianne Lee, PharmD; James Alan Kemp, MD, MPH; Adrianne Canning, RPh; Christine Egan, RPh; Gary Tataronis, MS; Francis A. Farraye, MD

Arch Intern Med. 1999;159:2312-2316.

Objectives  To determine whether an enhanced compliance program (ECP) improves patient compliance with bismuth subsalicylate, metronidazole, and tetracycline hydrochloride (BMT) triple therapy for the treatment of Helicobacter pylori infection and to identify factors that affect compliance with therapy.

Design  A randomized controlled trial conducted in 4 staff-model health centers of a health maintenance organization in Massachusetts.

Patients and Methods  A total of 125 patients 18 years of age or older with peptic ulcer disease or dyspepsia whose clinicians prescribed BMT triple therapy for 14 days were randomized to a control group or to the ECP group. The ECP group received medication counseling (written and oral) from a pharmacist, along with a medication calendar and a minipillbox, as well as a follow-up telephone call after initiation of therapy. Compliance was assessed by a pill count, and factors affecting adherence to the regimen were identified by patients' reports.

Results  There was no statistically significant difference between the 2 groups in the number of patients taking more than 60% of the medications (89% of the control group vs 95% of the ECP group; P>.30). However, there was a statistically significant difference in the number of patients taking more than 90% of the medications (67% of the control group vs 89% of the ECP group; P<.01). An intention-to-treat analysis confirmed these results. The most frequently reported adverse effect was gastrointestinal intolerance. Other factors reported to affect compliance included the frequency of dosing and the number of pills.

Conclusions  These findings suggest that although adverse effects were common, most patients were able to complete 60% or more of the 2-week regimen. An ECP further improved the percentage of medications taken.

From the Pharmacy (Dr Lee and Mss Canning and Egan) and the Department of Gastroenterology (Drs Kemp and Farraye), Harvard Vanguard Medical Associates, Brookline, Mass; and the School of Arts and Sciences, Massachusetts College of Pharmacy and Health Sciences, Boston (Mr Tataronis).

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