***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: The value of mailed educational videotapes as a means of enhancing compliance with drug therapy was studied . Members of a health maintenance organization with a pharmacy cl aim for benazepril , metoprolol , simvastatin , or transdermal estrogen  were r and omly assigned to a study group or a control group . Subjects in the study group were mailed one of four videotape programs giving information on the drug prescribed and the inferred disease state . Control subjects received no educational material s.  Subjects were enrolled from July 1 , 1993 , through January 2 , 1994 .  Refill data were collected from July 1 , 1993 , through April 1 , 1994 . The medication possession ratio ( MPR ) was calculated as the total number of days ' supply of a drug obtained by a member divided by the number of days between the time of enrollment and April 1 , 1994 , or the date the member was terminated from the plan . A subject was deemed compliant if his or her MPR was > or = 0.80 . There were no significant differences in mean MPRs between the study group ( n = 1993 ) and the control group ( n = 2253 ) . None of the mean MPRs was > or = 0.80 , although 44 % of control subjects and 46 % of study -group subjects were compliant . Of 97 respondents to a survey mailed to a r and omly selected subset of the study group , almost 87 % reported that they had viewed the videotapes , and of these subjects , about 88 % said they found them very useful or somewhat useful . A one-time mailing of videotapes to patients , with no individual follow-up , did not increase compliance with the medications monitored OBJECTIVE : Noxious adverse effects frequently limit patient acceptance of niacin and bile acid sequestrants ( BAS ) , first-line agents in the management of hypercholesterolemia .  The purpose of this study was to determine whether telephone contacts from a healthcare professional could improve drug adherence and tolerance in patients prescribed these medications . PATIENTS AND METHODS : This was a r and omized , single-blind trial of telephone contacts vs. no intervention in patients with hyperlipidemia who were prescribed either niacin or BAS in a large , Veterans Affairs , lipid clinic . Patients r and omized to telephone contact ( n=81 ) received weekly calls from a trained healthcare professional during the first month of drug therapy . Counseling regarding adverse effects , and prescriptions to overcome minor adverse effects , were provided as needed to patients during the telephone contact . RESULTS : Significant differences were not observed between groups in the drug discontinuance rate , adherence assessed by two independent methods , or in the final dosage of medication ingested . CONCLUSIONS : Telephone contacts do not improve either adherence or tolerance to niacin or BAS . Alternative approaches to enhance acceptance of these medications requires further evaluation BACKGROUND Noncompliance with cardiovascular therapy and prevention initiatives is well documented . OBJECTIVES The purpose of the First Myocardial Infa rct ion ( MI ) Risk Reduction Program , an open-label drug registry involving mainly primary -care patients at increased risk of a first MI , was to examine the effects of postal and telephone reminders , as well as demographic and other baseline characteristics , on patient self-reported compliance with pravastatin treatment . A second objective was to determine whether regimen adherence was associated with the adoption of other lifestyle modifications recommended to decrease the risk of coronary artery disease . METHODS Patients with risk scores of > or = 4 on a scale of -1 to + 16 for men and -1 to + 17 for women on the First Heart Attack Risk Test were considered to be at increased risk of a first MI and eligible for enrollment in the registry program . An elevated total cholesterol level despite dietary interventions was an additional inclusion criterion . Patients were prospect ively r and omized ( 4:1 ) to either an intervention involving postal and telephone reminders ( about coronary risk reduction and medication compliance ) , which were sent during the first 2 months of pravastatin treatment , or usual care . Both groups received reminder postcards at 4 and 5 months , in addition to counseling by physicians about coronary risk reduction . At 3 and 6 months ( or study discontinuation ) , patients completed and mailed to the program-coordinating center question naires concerning compliance with care , including current use of prescribed pravastatin , as well as self-reported adoption of other lifestyle modifications , such as changing eating habits , losing weight , increasing physical activity , and /or quitting smoking . Compliance with pravastatin therapy and with these coronary risk-reducing behaviors was also assessed by physicians at the 3-month follow-up visit . RESULTS A total of 10,335 patients were in the intervention group , and 2765 received usual care .  The 2 groups were well balanced at baseline with respect to age , race , and total cholesterol values . Neither early reminders nor baseline patient characteristics were significantly associated with reported  pravastatin compliance rates , which were approximately 79 % overall . However , according to self-reports at 6 months , regimen compliance was associated with the adoption of other coronary risk-reducing behaviors . CONCLUSIONS The results of this study suggest that early telephone and postal reminders do not improve compliance with drug treatment or with recommended coronary risk-reducing behaviors During the last quarter of the third year of follow-up in the Helsinki Heart Study , compliance to medication was measured in 1739 patients with digoxin used as a marker substance , capsule counting and a compliance question naire .  The estimates for good and poor compliers were found to be highly dependent on the method and the cut-off points chosen for the compliance allocation . The methods studied here were more reliable for the detection of poor rather than good compliance . In the poor compliance group , defined with the use of the digoxin marker , there was 39 % of subjects who returned less than 5 % of their capsule dosage or reported a deviation less than 5 % . In the good compliance group , defined by the digoxin marker , only 11.8 % of patients either returned or reported a deviation of at least 25 % of their dose . The compliance was better when measured by the question naire than by capsule counting . The size of the poor compliance group , defined by the use of the digoxin marker , was as large as a group who had returned at least 27 % of their capsule dose and a group who had reported a deviation of 11 % or more from their dosing schedule . The size of the group allocated to the good compliance category by the use of the digoxin marker was equivalent in size to a group of patients who had returned less than 15 % of their prescribed dose or reported a deviation of less than 6 % from their prescription . When the strictest criteria for the combination of all three methods were used , 57 % of subjects were classified as good and 31 % as poor compliers to medication in the third year of the primary prevention trial design ed to reduce the incidence of coronary heart disease STUDY OBJECTIVE To assess the accuracy of patient-kept diaries relative to electronic monitoring of compliance with isosorbide dinitrate prescribed 3 times/day for ischemic heart disease . DESIGN Unblinded , prospect i ve , three-phase study . METHODS Patients with coronary artery disease prescribed isosorbide dinitrate 3 times/day were asked to record the time of administration of each dose in a pocket diary while being monitored for compliance with a computerized Medication-Event Monitoring System ( MEMS-4 ) vial that electronically recorded the date and time the vial was opened . RESULTS Sixty-eight stable out patients with documented coronary artery disease who were prescribed isosorbide dinitrate 3 times/day were evaluated . Based on a prospect ively chosen definition including a nitrate-free period , the mean ( + /-SD ) overall compliance rates were 71 % ( + /-30 ) versus 55 % ( + /-32 ) for the patient-kept diaries and the MEMS vials respectively ( p = 0.001 ) . The concordance between patient-kept diaries and MEMS data indicate that 67 % of patients overestimate their compliance when using a self-recording tool . An average of 30 % of diary entries were in error compared with the MEMS vial recordings . CONCLUSIONS Patient-kept diaries statistically overestimate actual compliance relative to that determined by MEMS devices . Given the prevalence of the use of diaries as the predominant tool on which research ers depend to document compliance with study drugs , our findings suggest that this practice should be reevaluated specifically when the time of the dose and documentation of administration are critical to qualifying the outcome of drug therapy . Such is the case with isosorbide dinitrate use in patients with ischemic heart disease . Furthermore , the overall poor compliance documented in this study suggests that the utility of isosorbide dinitrate prescribed 3 times/day be reevaluated as a clinical ly effective antianginal drug The efficacy , safety , and tolerability of a moderate dose , 3-drug lipid-lowering regimen were evaluated among 29 male patients with hyperlipidemia and coronary artery disease . In an initial 12-month phase , regular niacin , 500 mg qid , lovastatin , 20 mg bid , and colestipol , 10 g/bid , were given with dose adjustment for lipid targets and side effects . This was followed by 2 r and om sequence crossover phases ( 8 months each ) alternating regular niacin with a polygel controlled-release formulation of niacin for use in this regimen . Lipid , lipoprotein , apoprotein , and clinical chemistry determinations were obtained at baseline , during the initial phase , at the 2 crossover phases , and at 6 weeks after therapy . A final question naire queried specific side effects and overall preferences . Low-/high-density lipoprotein ( LDL/HDL ) changed from means of 215/46 mg/dl at baseline , to 94/59 mg/dl after run-in , to 85/52 mg/dl after 8 months of controlled-release niacin , and to 98/56 mg/dl after 8 months of regular niacin ( regular niacin vs controlled-release niacin , p < 0.005/<0.05 ) . The target of LDL < or = 100 mg/dl was achieved at 8 months by 83 % of these patients with controlled-release niacin and by 52 % with regular niacin ( p < 0.01 ) . Compliance was 95 % with controlled-release niacin versus 85 % with regular niacin ( p < 0.001 ) . The controlled-release niacin and regular niacin regimens did not differ in terms of uric acid , glucose , insulin , or asparate aminotransferase levels . Overall , 21 % of patients called the 3 drugs " very easy " and 72 % " fairly easy " to take . The controlled-release niacin-containing regimen was preferred by 21 patients and the regular niacin by 4 . In conclusion , these regimens achieve striking lipid changes among hyperlipidemic patients . Controlled release is the preferred niacin preparation in terms of LDL reduction , compliance , patient preference , and achieving the National Cholesterol Education Program guideline of LDL < or = 100 mg/dl . The 2 niacin preparations did not differ in evidence of toxicity This r and omized , controlled trial evaluated the impact of personalized follow-up on compliance rates in high-risk patients receiving combination lipid-lowering therapy over 2 years . A r and om sample of 30 patients 7 - 30 days after cardiac surgery had baseline fasting low-density lipoprotein levels higher than 130 mg/dl . All patients received lovastatin 20 mg/day and colestipol 5 g twice/day . Weekly telephone contact was made with each patient for 12 weeks . Short- and long-term compliance was assessed by pill and packet counts and refill records . Compliance and lipid profile results were significantly better in the intervention group ( p<0.05 ) up to 2 years after the start of therapy than in the control group for all parameters except high-density lipoprotein . However , this effect was not apparent during the first 12 weeks of therapy . Short-term telephone follow-up favorably affected compliance and lipid profile results up to 2 years after start of therapy OBJECTIVE To analyse the efficacy of health education ( HE ) through group session with postal back-up in furthering compliance with therapy for Lipaemia . DESIGN Controlled clinical trial , with r and om distribution . SETTING Primary care . PATIENTS 110 patients with Hypercholesterolaemia , with new diagnoses or not in treatment , in which medical treatment with statins was indicated as a start or change in medication . INTERVENTIONS They were distributed in two groups at r and om , with observation four months after being included in the study and appointments after one , two and four months . 1 . Control group ( CG ) : 55 patients who received HE from their family doctor . 2 . Intervention group ( IG ) : 55 patients whose HE was monitored : a ) a group HE session and b ) back-up by letter sent to their homes . MEASUREMENTS AND RESULTS Patients whose consumption was between 80 and 110 % of the amount prescribed were defined as compliant . The pill count was recorded . The percentages of compliant patients and mean compliance ( chi squared , Student 's t ) were analysed . 108 individuals , 41 men and 67 women , completed the trial . There was no difference between the two groups as to age , sex , evolution time , number of diseases and dosage of medicines consumed . 71.3 % were compliant ( CI , 62.8 - 79.8 % ) , CG = 61.8 % and IG 81.1 % ( p < 0.05 ) . The mean percentage of compliance was 
    Output:
    
Intensified patient care appears to be the most promising intervention in terms of improved adherence to lipid-lowering drugs .