Study highlights value of observing patients to ensure they adhere to medical treatments

Red blood cells flowing through a vessel

“Adherence to therapy is a big problem, in particular for patients with chronic diseases that require lifelong therapies.”

- Dr. Marcel Ruzicka

Recent findings from Dr. Marcel Ruzicka and his research team suggest that observing patients taking their medication can be used as a tool to ensure they adhere to their prescribed course of treatment.

Dr. Ruzicka, associate professor in the Faculty of Medicine’s Department of Medicine and a clinician investigator at The Ottawa Hospital, was corresponding author of a study summarized in a research letter published June 17 in JAMA Internal Medicine.

Ruzicka and his team* studied patients whose hypertension, or high blood pressure, was believed to be resistant to treatment and who therefore ought to be referred to a specialist.

Their results showed that in some participants, if given treatment by another party and observed adhering to treatment schedule as opposed to being left to administer their own treatment, the patient’s hypertension resolved.

“Patients with apparent hypertension resistance are frequently subjected to costly, time consuming, and even invasive diagnostic tests to rule out rare forms of hypertension,” says Dr. Ruzicka. “But in some of them, it is just non-compliance with prescribed blood pressure lowering drugs which makes their hypertension ‘resistant’ to therapy.”

Ruzicka explains that according to their study, in some of these patients, non-compliance with blood pressure lowering drugs remained undetected with simple methods for assessment of adherence to therapy such as questioning, pill count, and review of pharmacy filling records. However, detection of non-compliance by direct observation tests spared these patients of costly and invasive tests.

In the future, observing patients with such a diagnosis more closely could help ensure adherence to treatment and resolve the condition, the team concluded.

Dr. Ruzicka feels the results also have profound implications for other medical conditions.

“Adherence to therapy is a big problem, in particular for patients with chronic diseases that require lifelong therapies,” explains Ruzicka, in support of the notion that no matter the medical condition, monitoring adherence to treatment can be of great value to a patient’s health.

The team plans to follow up with their study patients after 1 year, and also plans to explore whether psychological counselling could be beneficial in helping encourage patients to adhere to treatments on their own.

“It is important to assess causes of this particular type of non-compliance, and also to address those where detection of non-compliance by direct observation tests led to 'dis-engagement’ and loss of follow-up,” says Ruzicka.

* Faculty members Frans H. H. Leenen (Department of Cellular and Molecular Medicine), Tim Ramsay (School of Epidemiology and Public Health), Ann Bugeja (Department of Medicine), Cedric Edwards (Department of Medicine), Brendan McCormick (Department of Medicine), Swapnil Hiremath (Department of Medicine)


a blood pressure monitor next to a pile of medications



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