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


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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    • "In fact, the issue of non-adherence increases notably in older patients who have multiple morbidities (National Institute for Health and Care Excellence, 2015), which in turn requires managing multiple drugs and hence more memory resources. Both impaired memory and a high number of medicines commonly prescribed to older patients may explain the observed low adherence to medication that characterizes this population (Kripalani et al., 2007), above all when patients suffer from three or more morbidities and have to take three or more drugs (Tavares et al., 2013). Given that the population is aging and life expectancy is increasing, any procedure that helps patients to overcome their memory loss concerning medical treatment would foster their adherence to medical prescriptions and subsequent health improvement. "
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    ABSTRACT: Memory for medical recommendations is a prerequisite for good adherence to treatment, and therefore to ameliorate the negative effects of the disease, a problem that mainly affects people with memory deficits. We conducted a simulated study to test the utility of a procedure (the differential outcomes procedure, DOP) that may improve adherence to treatment by increasing the patient’s learning and retention of medical recommendations regarding medication. The DOP requires the structure of a conditional discriminative learning task in which correct choice responses to specific stimulus–stimulus associations are reinforced with a particular reinforcer or outcome. In two experiments, participants had to learn and retain in their memory the pills that were associated with particular disorders. To assess whether the DOP improved long-term retention of the learned disorder/pill associations, participants were asked to perform two recognition memory tests, 1 h and 1 week after completing the learning phase. The results showed that compared with the standard non-differential outcomes procedure, the DOP produced better learning and long-term retention of the previously learned associations. These findings suggest that the DOP can be used as a useful complementary technique in intervention programs targeted at increasing adherence to clinical recommendations.
    Frontiers in Psychology 12/2015; 6. DOI:10.3389/fpsyg.2015.01780 · 2.80 Impact Factor
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    • "Medication non-adherence is a widespread problem in the United States, increasing safety risks for patients and placing a significant financial burden on the healthcare industry [1]. Poor adherence to medication often results in substantial worsening of a disease, increased mortality, and unnecessary healthcare costs [2] [3]. For the purposes of this paper, we limit the definition of adherence to the medication regimen a physician prescribes, and a patient's commitment to taking those medications as prescribed. "
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    ABSTRACT: Medication non-adherence is a major concern in the healthcare industry and has led to increases in health risks and medical costs. For many neurological diseases, adherence to medication regimens can be assessed by observing movement patterns. However, physician observations are typically assessed based on visual inspection of movement and are limited to clinical testing procedures. Consequently, medication adherence is difficult to measure when patients are away from the clinical setting. The authors propose a data mining driven methodology that uses low cost, non-wearable multimodal sensors to model and predict patients' adherence to medication protocols, based on variations in their gait. The authors conduct a study involving Parkinson's disease patients that are "on" and "off" their medication in order to determine the statistical validity of the methodology. The data acquired can then be used to quantify patients' adherence while away from the clinic. Accordingly, this data-driven system may allow for early warnings regarding patient safety. Using whole-body movement data readings from the patients, the authors were able to discriminate between PD patients on and off medication, with accuracies greater than 97% for some patients using an individually customized model and accuracies of 78% for a generalized model containing multiple patient gait data. The proposed methodology and study demonstrate the potential and effectiveness of using low cost, non-wearable hardware and data mining models to monitor medication adherence outside of the traditional healthcare facility. These innovations may allow for cost effective, remote monitoring of treatment of neurological diseases.
    Computers in Biology and Medicine 09/2015; 66:120-134. DOI:10.1016/j.compbiomed.2015.08.012 · 1.24 Impact Factor
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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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