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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    • "The effectiveness of all prescribed treatments is contingent on patient adherence. Evidence suggests that adherence problems occur in 50% to 75% of patients with chronic disorders [14]. The reported levels of adherence to rhGH therapy are highly variable, but it has been suggested that non-adherence might be as high as 36% to 49% [3]. "

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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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