The DOI matches its Crossref record; 640 of the 645 references it cites were found in a registry or an index.
Interventions for enhancing medication adherence
Open accessAbstract
BACKGROUND: People who are prescribed self administered medications typically take only about half their prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications. OBJECTIVES: The primary objective of this review is to assess the effects of interventions intended to enhance patient adherence to prescribed medications for medical conditions, on both medication adherence and clinical outcomes. SEARCH METHODS: We updated searches of The Cochrane Library, including CENTRAL (via http://onlinelibrary.wiley.com/cochranelibrary/search/), MEDLINE, EMBASE, PsycINFO (all via Ovid), CINAHL (via EBSCO), and Sociological Abstracts (via ProQuest) on 11 January 2013 with no language restriction. We also reviewed bibliographies in articles on patient adherence, and contacted authors of relevant original and review articles. SELECTION CRITERIA: We included unconfounded RCTs of interventions to improve adherence with prescribed medications, measuring both medication adherence and clinical outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive findings at earlier time points. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted all data and a third author resolved disagreements. The studies differed widely according to medical condition, patient population, intervention, measures of adherence, and clinical outcomes. Pooling results according to one of these characteristics still leaves highly heterogeneous groups, and we could not justify meta-analysis. Instead, we conducted a qualitative analysis with a focus on the RCTs with the lowest risk of bias for study design and the primary clinical outcome. MAIN RESULTS: The present update included 109 new RCTs published since the previous update in January 2007, bringing the total number of RCTs to 182; we found five RCTs from the previous update to be ineligible and excluded them. Studies were heterogeneous for patients, medical problems, treatment regimens, adherence interventions, and adherence and clinical outcome measurements, and most had high risk of bias. The main changes in comparison with the previous update include that we now: 1) report a lack of convincing evidence also specifically among the studies with the lowest risk of bias; 2) do not try to classify studies according to intervention type any more, due to the large heterogeneity; 3) make our database available for collaboration on sub-analyses, in acknowledgement of the need to make collective advancement in this difficult field of research. Of all 182 RCTs, 17 had the lowest risk of bias for study design features and their primary clinical outcome, 11 from the present update and six from the previous update. The RCTs at lowest risk of bias generally involved complex interventions with multiple components, trying to overcome barriers to adherence by means of tailored ongoing support from allied health professionals such as pharmacists, who often delivered intense education, counseling (including motivational interviewing or cognitive behavioral therapy by professionals) or daily treatment support (or both), and sometimes additional support from family or peers. Only five of these RCTs reported improvements in both adherence and clinical outcomes, and no common intervention characteristics were apparent. Even the most effective interventions did not lead to large improvements in adherence or clinical outcomes. AUTHORS' CONCLUSIONS: Across the body of evidence, effects were inconsistent from study to study, and only a minority of lowest risk of bias RCTs improved both adherence and clinical outcomes. Current methods of improving medication adherence for chronic health problems are mostly complex and not very effective, so that the full benefits of treatment cannot be realized. The research in this field needs advances, including improved design of feasible long-term interventions, objective adherence measures, and sufficient study power to detect improvements in patient-important clinical outcomes. By making our comprehensive database available for sharing we hope to contribute to achieving these advances.
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“Although there is a wealth of controlled trials on interventions to improve adherence, current methods of improving medication adherence for chronic health problems are mostly complex and not effective [2,3,4].”
From Factors Contributing to Medication Adherence in Patients with a Chronic Condition: A Scoping Review of Qualitative Research (2021) · cites this paper as [3]
In the citing paper
“This review is in agreement with other, CF-related reviews and general adherence reviews, which have highlighted the limitations of many included trials in terms of having small sample sizes and being underpowered to detect a meaningful difference in adherence (Goldbeck 2014; Nieuwlaat 2014).”
From Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (2023) · cites this paper as Nieuwlaat 2014
In the citing paper
“Previous Cochrane Reviews on adherence (Nieuwlaat 2014) and CF-specific reviews (Goldbeck 2014; Savage 2014) have not used a coding framework, so this review has improved on existing methodologies.”
From Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (2023) · cites this paper as Nieuwlaat 2014
In the citing paper
“Given the complexity of many adherence interventions tested to date (Nieuwlaat 2014), and the way in which complex interventions are reported or described in the literature, it is o en difficult to determine the content, or the 'active ingredients', of effective interventions that bring about change (Michie 2009).”
From Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (2023) · cites this paper as Nieuwlaat 2014
In the citing paper
“Understanding the 'active ingredients' of promising interventions will make it easier to replicate effective interventions; will reduce the potential waste of time and resources on trials of ineffective techniques (Michie 2009); and will inform adherence research in the future (Nieuwlaat 2014).”
From Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (2023) · cites this paper as Nieuwlaat 2014
In the citing paper
“A previous Cochrane Review highlighted likely inclusion bias in adherence trials, with participants having higher than average adherence at baseline (Nieuwlaat 2014).”
From Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (2023) · cites this paper as Nieuwlaat 2014
In the citing paper
“Underpowered trials are more likely to miss a meaningful difference in adherence, even when improving adherence substantially, and showing an effect on clinical outcomes is likely even harder (Nieuwlaat 2014).”
From Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (2023) · cites this paper as Nieuwlaat 2014
In the citing paper
“Interventions that specifically aim to improve adherence to prescribed medications vary widely (Nieuwlaat 2014).”
From Psychological interventions for improving adherence to inhaled therapies in people with cystic fibrosis (2023) · cites this paper as Nieuwlaat 2014
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“Although the terms ‘adherence’ and ‘compliance’ are distinct in meaning in the healthcare lexicon as proposed by World Health Organization [11], ‘patient adherence’ and ‘patient compliance’ in this context were interchangeable and both referred to the extent to which consumers follow instructions they are given for pr…”
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Cartwright, B. R., & Goodman, J. M. (2012) · Journal of Lipid Research · doi:10.1194/jlr.r023754 · Cited by 160
Adherence in childhood asthma: the elephant in the room
Morton, R., Everard, M. L., & Elphick, H. (2014) · Archives of Disease in Childhood · doi:10.1136/archdischild-2014-306243 · Cited by 157
Primary non-adherence in general practice: a Danish register study
Pottegård, A., Christensen, R. D., Houji, A., Christiansen, C. B., Paulsen, M. S., Thomsen, J. L., & Hallas, J. (2014) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-014-1677-y · Cited by 157
Understanding Medication Nonadherence after Kidney Transplant
Nevins, T. E., Nickerson, P. W., & Dew, M. A. (2017) · Journal of the American Society of Nephrology · doi:10.1681/asn.2017020216 · Cited by 159
Financial arrangements for health systems in low-income countries: an overview of systematic reviews
Wiysonge, C. S., Paulsen, E., Lewin, S. A., Ciapponi, A., Herrera, C. A., Opiyo, N., Tomás Pantoja, C., Gabriel Rada, G., & Oxman, A. D. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011084.pub2 · Cited by 169
McArthur, D., Dumas, A., Woodend, K., Beach, S., & Stacey, D. (2014) · BMC Women s Health · doi:10.1186/1472-6874-14-49 · Cited by 156
Vangeli, E., Bakhshi, S., Baker, A. H., Fisher, A., Bucknor, D., Mrowietz, U., Östör, A. J. K., Peyrin‐Biroulet, L., Lacerda, A. P., & Weinman, J. A. (2015) · Advances in Therapy · doi:10.1007/s12325-015-0256-7 · Cited by 156
“Increasing adherence may have a far greater impact on health outcomes than advances in medical treatments [5, 6].”
BackgroundHow to Construct, Conduct and Analyze an Exercise Training Study?
Hecksteden, A., Faude, O., Meyer, T., & Donath, L. (2018) · Frontiers in Physiology · doi:10.3389/fphys.2018.01007 · Cited by 156
Gwadry-Sridhar, F. H., Manias, E., Lal, L., Salas, M., Hughes, D. A., Ratzki-Leewing, A., & Grubisic, M. (2013) · Value in Health · doi:10.1016/j.jval.2013.03.1631 · Cited by 155
The association of health literacy with adherence and outcomes in moderate-severe asthma
Apter, A. J., Wan, F., Reisine, S., Bender, B. G., Rand, C. S., Bogen, D. K., Bennett, I. M., Bryant-Stephens, T. C., Roy, J. A., Gonzalez, R., et al. (2013) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2013.02.014 · Cited by 160
Barriers and facilitators to medication adherence: a qualitative study with general practitioners
Kvarnström, K., Airaksinen, M., & Liira, H. (2018) · BMJ Open · doi:10.1136/bmjopen-2016-015332 · Cited by 159
“11 The Cochrane review advised that shifting medication counselling to allied healthcare providers seems a reasonable and potentially cost-effective strategy.(6) Although there strengths and limitations of this study”
BackgroundInfluentialKosse, R. C., Bouvy, M. L., de Vries, T. W., & Koster, E. S. (2019) · Respiratory Medicine · doi:10.1016/j.rmed.2019.02.009 · Cited by 155
Palmer, M., Sutherland, J., Barnard, S., Wynne, A., Rezel, E., Doel, A., Grigsby-Duffy, L., Edwards, S., Russell, S., Hotopf, E., et al. (2018) · PLOS ONE · doi:10.1371/journal.pone.0189801 · Cited by 136
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Factors influencing adherence to treatment in older adults with hypertension
Uchmanowicz, B., Chudiak, A., Uchmanowicz, I., Rosińćzuk, J., & Froelicher, E. S. (2018) · Clinical Interventions in Aging · doi:10.2147/cia.s182881 · Cited by 154
“11,12 AlGhurair et al 13 demonstrated in their meta-analysis that adult adherence can be placed into these additional five categories: demographic, medical, medication, behavioral, and economic.”
Why are we failing to implement effective therapies in cardiovascular disease?
Nieuwlaat, R., Schwalm, J.-D., Khatib, R., & Yusuf, S. (2013) · European Heart Journal · doi:10.1093/eurheartj/ehs481 · Cited by 155
Self-citationThe use of incentives to reinforce medication adherence
DeFulio, A., & Silverman, K. (2012) · Preventive Medicine · doi:10.1016/j.ypmed.2012.04.017 · Cited by 158
Zomahoun, H. T. V., Guénette, L., Grégoire, J., Lauzier, S., Lawani, M. A., Ferdynus, C., Huiart, L., & Moisan, J. (2016) · International Journal of Epidemiology · doi:10.1093/ije/dyw273 · Cited by 153
“The very small pooled effect size that we observed is in line with the results of a recent systematic review of RCTs on interventions aiming to enhance medication adherence, irrespective of the type of intervention.(51) In this latter review, the authors observed that improvement in adherence was minimal.”
ResultFactors associated with low adherence to medicine treatment for chronic diseases in Brazil
Tavares, N. U. L., Bertoldi, A. D., Mengue, S. S., Arrais, P. S. D., Luiza, V. L., Oliveira, M. A., Ramos, L. R., Farías, M. R., & Pizzol, T. D. S. D. (2016) · Revista de Saúde Pública · doi:10.1590/s1518-8787.2016050006150 · Cited by 153
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“of patient education, reminders, reinforcement, and convenience (47,48), which will necessitate sophisticated coordination of care (49).”
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What are the most effective strategies for improving quality and safety of health care?
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Improving medication adherence in chronic obstructive pulmonary disease: a systematic review
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Abdalla, M., Bolen, S. D., Brettler, J. W., Egan, B. M., Ferdinand, K. C., Ford, C. D., Lackland, D. T., Wall, H. K., & Shimbo, D. (2023) · Hypertension · doi:10.1161/hyp.0000000000000232 · Cited by 166
Evidence-Based Strategies for the Optimization of Pharmacotherapy in Older People
Topinková, E., Baeyens, J., Michel, J., & Lang, P. O. (2012) · Drugs & Aging · doi:10.2165/11632400-000000000-00000 · Cited by 165
Adherence to therapy and adverse drug reactions: is there a link?
Leporini, C., Sarro, G. D., & Russo, E. (2014) · Expert Opinion on Drug Safety · doi:10.1517/14740338.2014.947260 · Cited by 150
“Therefore, interventions aimed at improving adherence tend to have a multidimensional approach, including simplification of medication regimen and patient educational counseling [13].”
BackgroundAsthma inhaler adherence determinants in adults: systematic review of observational data
Dima, A. L., Hernández, G., Cunillera, O., Ferrer, M., de Bruin, M., & the ASTRO-LAB group (2014) · European Respiratory Journal · doi:10.1183/09031936.00172114 · Cited by 154
“Healthcare team and system factors were rarely studied, although the improvement of health services for chronic conditions is currently a priority [89] and adherence-enhancing interventions usually include changes in the structure of healthcare delivery [10].”
BackgroundLambert, K., Mullan, J., & Mansfield, K. J. (2017) · BMC Nephrology · doi:10.1186/s12882-017-0734-z · Cited by 156
“However, the low rate of adherence to the overall renal diet as well as to specific components such as energy, protein, sodium, total fat and fibre reported in this review suggests that designing interventions to improve dietary adherence in those with ESKD is required [132].”
BackgroundAdverse Drug Events as a Cause of Hospitalization in Older Adults
Salvi, F., Marchetti, A., D’Angelo, F., Boemi, M., Lattanzio, F., & Cherubini, A. (2012) · Drug Safety · doi:10.1007/bf03319101 · Cited by 153
Adherence and persistence with taking medication to control high blood pressure
Hill, M. N., Miller, N. H., & Geest, S. D. (2011) · Journal of the American Society of Hypertension · doi:10.1016/j.jash.2011.01.001 · Cited by 154
Roberts, M. C., Wheeler, S. B., & Reeder-Hayes, K. E. (2015) · American Journal of Public Health · doi:10.2105/ajph.2014.302490 · Cited by 142
“We included studies that explored both (1) racial/ethnic or socioeconomic variation in ET initiation, adherence, or persistence and (2) barriers to ET that varied by race/ethnicity or SES through the use of interaction terms for race, ethnicity, and SES with other factors (e.”
BackgroundFoster, B. J., Pai, A. L. H., Zelikovsky, N., Amaral, S. G., Bell, L., Dharnidharka, V. R., Hébert, D., Holly, C. D., Knaüper, B., Matsell, D. G., et al. (2018) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2017.12.012 · Cited by 146
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Adherence to Vitamin D Recommendations Among US Infants
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“Despite the well-documented need for improved adherence to prescribed medical treatments for chronic health conditions [1,2], interventions targeting treatment adherence have had modest results, and typically demonstrate small effect sizes [3].”
BackgroundVitamin D3 supplementation during weight loss: a double-blind randomized controlled trial
Mason, C. E., Xiao, L., Imayama, I., Duggan, C. R., Wang, C., Korde, L. A., & McTiernan, A. (2014) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.113.073734 · Cited by 137
Shared Decision Making for Antidepressants in Primary Care
LeBlanc, A., Herrin, J. S., Williams, M. D., Inselman, J., Branda, M. E., Shah, N. D., Heim, E. M., Dick, S. R., Linzer, M., Boehm, D. H., et al. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.5214 · Cited by 139
Mobile phone-based interventions for improving contraception use
Smith, C. E., Gold, J., Ngo, T. D., Sumpter, C., & Free, C. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011159.pub2 · Cited by 140
Kucukarslan, S. N. (2012) · Research in Social and Administrative Pharmacy · doi:10.1016/j.sapharm.2011.09.002 · Cited by 138
Adherence to Antihypertensive Therapy
Peacock, E., & Krousel-Wood, M. A. (2016) · Medical Clinics of North America · doi:10.1016/j.mcna.2016.08.005 · Cited by 150
Effectiveness of clinical pharmacy services: an overview of systematic reviews (2000–2010)
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Metadata
- Authors
- Nieuwlaat, R., Wilczynski, N., Navarro, T., Hobson, N., Jeffery, R., Keepanasseril, A., Agoritsas, T., Mistry, N., Iorio, A., Jack, S., Sivaramalingam, B., Iserman, E., Mustafa, R. A., Jedraszewski, D., Cotoi, C., & Haynes, R. B.
- Affiliations
- Hamilton General Hospital (CA)
- McMaster University (CA)
- St. Michael's Hospital (CA)
- University of Guelph (CA)
- ORCID
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2014-11-20
- Volume
- 2014
- Issue
- 11
- Pages
- CD000011-CD000011
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC7263418
- OpenAlex
- W1594567624
- Cited by
- 2,945
- References
- 645
- Citations by year
- 2026: 64 · 2025: 119 · 2024: 108 · 2023: 147 · 2022: 157 · 2021: 177 · 2020: 200 · 2019: 190 · 2018: 209 · 2017: 244 · 2016: 224 · 2015: 191 · 2014: 214
- FWCI
- 37.90
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Health Professions › Pharmacy › Pharmacy and Medical Practices
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Patient Safety and Medication Errors
- Keywords
- medication adherence, adherence interventions, self-administered medication, clinical outcomes, risk of bias, quality of evidence, pill organizers, pharmacists
- MeSH terms
- Drug Therapy, Humans, Patient Education as Topic, Self Administration, Randomized Controlled Trials as Topic, Publication Bias, Medication Adherence
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