Interventions to Enhance Medication Adherence in Chronic Medical Conditions: A Systematic Review

Division of General Medicine, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA.
Archives of Internal Medicine (Impact Factor: 17.33). 04/2007; 167(6):540-50. DOI: 10.1001/archinte.167.6.540
Source: PubMed

ABSTRACT Approximately 20% to 50% of patients are not adherent to medical therapy. This review was performed to summarize, categorize, and estimate the effect size (ES) of interventions to improve medication adherence in chronic medical conditions.
Randomized controlled trials published from January 1967 to September 2004 were eligible if they described 1 or more unconfounded interventions intended to enhance adherence with self-administered medications in the treatment of chronic medical conditions. Trials that reported at least 1 measure of medication adherence and 1 clinical outcome, with at least 80% follow-up during 6 months, were included. Study characteristics and results for adherence and clinical outcomes were extracted. In addition, ES was calculated for each outcome.
Among 37 eligible trials (including 12 informational, 10 behavioral, and 15 combined informational, behavioral, and/or social investigations), 20 studies reported a significant improvement in at least 1 adherence measure. Adherence increased most consistently with behavioral interventions that reduced dosing demands (3 of 3 studies, large ES [0.89-1.20]) and those involving monitoring and feedback (3 of 4 studies, small to large ES [0.27-0.81]). Adherence also improved in 6 multisession informational trials (small to large ES [0.35-1.13]) and 8 combined interventions (small to large ES [absolute value, 0.43-1.20]). Eleven studies (4 informational, 3 behavioral, and 4 combined) demonstrated improvement in at least 1 clinical outcome, but effects were variable (very small to large ES [0.17-3.41]) and not consistently related to changes in adherence.
Several types of interventions are effective in improving medication adherence in chronic medical conditions, but few significantly affected clinical outcomes.

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Available from: Xiaomei Yao, Apr 15, 2014
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    • "Cardiology guidelines on cardiovascular disease prevention recommend physicians to assess adherence to medication and to identify reasons for non-adherence in order to tailor interventions to the individual needs of the patient [19]. Improvement of communication skills and working on an improved patient–physician alliance has been shown to improve medication adherence [37] [38]. Besides continuing and improving patients' education and secondary preventive efforts at discharge and during CR phase, the pertinence of studying interventions in the outpatient settings, including treating physicians, might be a critical step for improving the application for evidence in clinical practice and the prognosis of patients after an ACS [19]. "
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    ABSTRACT: Background: The prescription of recommended medical therapies is a key factor to improve prognosis after acute coronary syndromes (ACS). However, reasons for cardiovascular therapies discontinuation after hospital discharge are poorly reported in previous studies. Methods: We enrolled 3055 consecutive patients hospitalized with a main diagnosis of ACS in four Swiss university hospitals with a prospective one-year follow-up. We assessed the self-reported use of recommended therapies and the reasons for medication discontinuation according to the patient interview performed at one-year follow-up. Results: 3014 (99.3%) patients were discharged with aspirin, 2983 (98.4%) with statin, 2464 (81.2%) with beta-blocker, 2738 (90.3%) with ACE inhibitors/ARB and 2597 (100%) with P2Y12 inhibitors if treated with coronary stent. At the one-year follow-up, the discontinuation percentages were 2.9% for aspirin, 6.6% for statin, 11.6% for beta-blocker, 15.1% for ACE inhibitor/ARB and 17.8% for P2Y12 inhibitors. Most patients reported having discontinued their medication based on their physicians' decision: 64 (2.1%) for aspirin, 82 (2.7%) for statin, 212 (8.6%) for beta-blocker, 251 (9.1% for ACE inhibitor/ARB) and 293 (11.4%) for P2Y12 inhibitors, while side effect, perception that medication was unnecessary and medication costs were uncommon reported reasons (<2%) according to the patients. Conclusions: Discontinuation of recommended therapies after ACS differs according the class of medication with the lowest percentages for aspirin. According to patients, most stopped their cardiovascular medication based on their physician's decision, while spontaneous discontinuation was infrequent.
    European Journal of Internal Medicine 01/2015; 26(1). DOI:10.1016/j.ejim.2014.12.014 · 2.89 Impact Factor
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    • "Furthermore, the selected studies were required to report one measure for assessing medication adherence and/or assessment of one clinical outcome for showing effectiveness of the intervention. Additionally, review articles that summarized the current status of research on adherence-enhancing interventions in chronic conditions were also selected and corresponding references therein were retrieved for full-text review [1, 26, 34, 40, 46, 55, 73, 80]. Furthermore, 14 publications, which were not identified via the literature search but which were known to the authors as being relevant, were included in the pool of the literature retrieved for full-text review [10, 15, 20, 21, 23, 31, 39, 47, 52, 62, 63, 65, 76, 77]. "
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    ABSTRACT: Psoriasis is a common, disabling, chronic, relapsing, inflammatory disorder of the skin with a worldwide prevalence of 2–3 % in which adherence to treatment is often poor. The majority of individuals have limited disease that is being treated with topical medication according to existing guidelines. Adherence rates are lower for topical compared with systemic treatment. Low medication adherence is a major problem for patients with chronic disorders as it results in suboptimal treatment outcomes, increased risk for development of concomitant diseases, inefficient use of health resources and considerable losses to society. However, to date no adherence-enhancing intervention has been developed for psoriasis patients under topical treatment. In this article, we report the development of the topical treatment optimization program (TTOP). The TTOP intervention aims to improve the information given to the patients and to result in an engaged patient–physician relationship. Application of the TTOP intervention in daily clinical practice may lead to a significant increase of adherence and the successful management of psoriasis and other chronic skin disorders. Electronic supplementary material The online version of this article (doi:10.1007/s00403-014-1475-5) contains supplementary material, which is available to authorized users.
    Archives for Dermatological Research 06/2014; 306(7). DOI:10.1007/s00403-014-1475-5 · 1.90 Impact Factor
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    • "Patients that have a stronger belief in the necessity for eye drops are more adherent [3] and studies that have targeted patient beliefs have been effective in improving adherence [4,5]. Conversely, whilst poor glaucoma education has been cited as an explanation for non-adherence to therapy [6-8], interventions that purely focus on providing education have failed to achieve significant improvement in adherence [9-11]. "
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    ABSTRACT: Improving adherence to ocular hypertension (OH)/glaucoma therapy is highly likely to prevent or reduce progression of optic nerve damage. The present study used a behaviour change counselling intervention to determine whether education and support was beneficial and cost-effective in improving adherence with glaucoma therapy. A randomised controlled trial with a 13-month recruitment and 8-month follow-up period was conducted. Patients with glaucoma/OH attending a glaucoma clinic and starting treatment with travoprost were approached. Participants were randomised into two groups and adherence was measured over 8 months, using an electronic monitoring device (Travalert(R) dosing aid, TDA). The control group received standard clinical care, and the intervention group received a novel glaucoma education and motivational support package using behaviour change counselling. Cost-effectiveness framework analysis was used to estimate any potential cost benefit of improving adherence. Two hundred and eight patients were recruited (102 intervention, 106 control). No significant difference in mean adherence over the monitoring period was identified with 77.2% (CI, 73.0, 81.4) for the control group and 74.8% (CI, 69.7, 79.9) for the intervention group (p = 0.47). Similarly, there was no significant difference in percentage intraocular pressure reduction; 27.6% (CI, 23.5, 31.7) for the control group and 25.3% (CI, 21.06, 29.54) for the intervention group (p = 0.45). Participants in the intervention group were more satisfied with information about glaucoma medication with a mean score of 14.47/17 (CI, 13.85, 15.0) compared with control group which was 8.51 (CI, 7.72, 9.30). The mean intervention cost per patient was GB[pound sign]10.35 (<US$16) and not cost-effective. Adherence with travoprost was high and not further increased by the intervention. Nevertheless, the study demonstrated that provision of information, tailored to the individual, was inexpensive and able to achieve high patient satisfaction with respect to information about glaucoma medication. Measurement of adherence remains problematic since awareness of study participation may cause a change in participant behaviour.Trial registration: Current Controlled Trials, ISRCTN89683704.
    BMC Ophthalmology 03/2014; 14(1):32. DOI:10.1186/1471-2415-14-32 · 1.02 Impact Factor
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