What happens with patients after participation in a clinical trial?

107 patients with primary hypercholesterolaemia participated for five years in a clinical trial with dietary and drug treatment (a statin) at the Lipid Clinic. At the end of the study the patients were referred back to their own physicians, with written advice on diet and drug therapy. At a recall two years later we studied to what extent recommended therapy and follow-up had been implemented. 15% had no follow-up after participating in the study and 18% had not measured their cholesterol for one year or more. The majority of the patients did not follow the recommended diet and level of physical activity satisfactorily, and 20% had stopped their lipid-lowering medication. In general they had been prescribed too low doses of the lipid-lowering agent, and 70% of the patients had not reached the target of the LDL-cholesterol. In conclusion, adequate treatment and a five-year follow-up is not sufficient to keep the patient compliant when the follow-up becomes less intensive. When a clinical trial is terminated, greater efforts should be made to secure better compliance to therapy.     

The management of pulmonary tuberculosis in adults notified in Scotland in 1993

The management of pulmonary tuberculosis (TB) in Scotland in 1993 was studied by asking the physicians responsible for all 321 adult cases of the disease notified that year to complete a standardized questionnaire relating to drug treatment and bacteriology. The response rate to the questionnaire was 100%. Isoniazid and rifampicin were used together in initial therapy in 98.4% of cases, while pyrazinamide was prescribed in 90.3% of cases, broadly in keeping with existing treatment guidelines. However, considerable variability was observed both in the drug regimens employed, and in the duration of initial and continuation phases of chemotherapy. Treatment regimens were therefore frequently at variance with published recommendations. Among patients prescribed drug regimens other than those recommended satisfactory completion of therapy was less common. Microbiological confirmation was provided for 84% of cases in which clinical samples were submitted. However, in approximately 11% of cases, no clinical samples were submitted. Closer adherence to existing treatment guidelines and more rigorous pursuit of microbiological confirmation should further improve the overall management of pulmonary TB in Scotland.