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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Timmerman, L., Stronks, D. L., Groeneweg, J. G., & Huygen, F. J. (2016) · Acta Anaesthesiologica Scandinavica · doi:10.1111/aas.12697 · Cited by 132
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de Bruin, M., Hospers, H. J., van Breukelen, G., Kok, G., Koevoets, W. M., & Prins, J. M. (2010) · Health Psychology · doi:10.1037/a0020335 · Cited by 136
Medication adherence and its determinants in patients after myocardial infarction
Pietrzykowski, Ł., Michalski, P., Kosobucka, A., Kasprzak, M., Fabiszak, T., Stolarek, W., Siller-Matula, J. M., & Kubica, A. (2020) · Scientific Reports · doi:10.1038/s41598-020-68915-1 · Cited by 136
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Hollands, G. J., McDermott, M. S., Lindson, N., Vogt, F., Farley, A., & Aveyard, P. N. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009164.pub2 · Cited by 136
Medication adherence interventions and outcomes: an overview of systematic reviews
Wilhelmsen, N. C., & Eriksson, T. (2018) · European Journal of Hospital Pharmacy · doi:10.1136/ejhpharm-2018-001725 · Cited by 133
“10 Many patients who continue taking their medication do not do it consistently as prescribed.”
BackgroundConscientiousness and medication adherence: A meta-analysis
Molloy, G. J., O’Carroll, R. E., & Ferguson, E. (2014) · Annals of Behavioral Medicine · doi:10.1007/s12160-013-9524-4 · Cited by 130
Patient education and counselling for promoting adherence to treatment for tuberculosis
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Hall, J., Peat, M., Birks, Y. F., Golder, S., on behalf of the PIPS Group, Entwistle, V. A., Gilbody, S. M., Mansell, P., McCaughan, D., Sheldon, T., et al. (2010) · BMJ Quality & Safety · doi:10.1136/qshc.2009.032748 · Cited by 132
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“Review of adherence in randomized controlled trials on cardiovascular disease prevention strategies identified the following successful approaches: signed agreements, behavioral skill training, self-monitoring, telephone or mail contact, spouse or other key person support, self-efficacy enhancement, contingency contra…”
BackgroundHadji, P., Blettner, M., Harbeck, N., Jackisch, C., Lück, H.-J., Windemuth-Kieselbach, C., Zaun, S., & Kreienberg, R. (2013) · Annals of Oncology · doi:10.1093/annonc/mds653 · Cited by 122
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Anderson, L. J., Nuckols, T. K., Coles, C., Le, M. M., Schnipper, J. L., Shane, R., Jackevicius, C., Lee, J., Pevnick, J. M., Members of the PHARM-DC Group, et al. (2020) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/zxz284 · Cited by 122
“The remaining 4 reviews that focused generally on medication adherence interventions either concluded that interventions did not improve adherence or that they were precluded from drawing conclusions due to limitations in study number or quality.(22,24,31,39) Dose simplification.”
BackgroundThe role of adherence in patients with chronic diseases
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“Study Quality Where others found a lack of high-quality studies and stressed the importance of improving study quality [3,9,15], this review included 15 (out of 23) high-quality studies.”
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“A recent Cochrane review revealed that only a minority of studies with lowest risk of bias (RCT design) improved both adherence and clinical outcomes [20].”
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Dobbels, F., Bleser, L. D., Berben, L., Kristanto, P., Dupont, L., Nevens, F., Vanhaecke, J., Verleden, G. M., & Geest, S. D. (2017) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2017.01.007 · Cited by 121
Hershman, D. L., Tsui, J., Wright, J. D., Coromilas, E. J., Tsai, W. Y., & Neugut, A. I. (2015) · Journal of Clinical Oncology · doi:10.1200/jco.2014.58.3062 · Cited by 121
A study of a multi-level intervention to improve non-adherence in difficult to control asthma
Gamble, J., Stevenson, M., & Heaney, L. G. (2011) · Respiratory Medicine · doi:10.1016/j.rmed.2011.03.019 · Cited by 120
Routine deprescribing of chronic medications to combat polypharmacy
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“The reasons for the exclusion of the 33 articles following full article screening were as follows: nine (9) studies were literature reviews [22, 31, 32, 33, 34, 35, 36, 37, 38]; eighteen (18) studies [39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56] were conducted in high-income countries; two”
BackgroundImproving Medication Adherence in Patients with Hypertension: A Randomized Trial
Hedegaard, U., Kjeldsen, L. J., Pottegård, A., Henriksen, J. E., Lambrechtsen, J., Hangaard, J., & Hallas, J. (2015) · The American Journal of Medicine · doi:10.1016/j.amjmed.2015.08.011 · Cited by 119
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Strategies to improve drug adherence
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“Evidence from a recent systematic review of adherence strategies [30] as well as experience in patients with cystic fibrosis,[26] obesity,[27] diabetes,[28,31,32] and chronic pain [33] suggest that a personalized, multicomponent smartphone app may represent a better solution to low adherence rates in AYA with SCD.”
BackgroundMedication Adherence in Patients with Parkinson’s Disease
Malek, N., & Grosset, D. G. (2014) · CNS Drugs · doi:10.1007/s40263-014-0220-0 · Cited by 118
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Psychological Determinants of Heart Failure Self-Care: Systematic Review and Meta-Analysis
Kessing, D., Denollet, J., Widdershoven, J., & Kupper, N. (2016) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000270 · Cited by 113
“In terms of optimizing HF self-care, clinicians are suggested to provide HF education and to address inadequate health or self-care beliefs or barriers, for instance, through motivational interviewing (107,108).”
BackgroundZedler, B. K., Kakad, P. P., Colilla, S., Murrelle, L., & Shah, N. R. (2011) · Clinical Therapeutics · doi:10.1016/j.clinthera.2011.02.003 · Cited by 116
Adherence to Long-Term Therapies and Beliefs about Medications
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Patton, D., Hughes, C. M., Cadogan, C. A., & Ryan, C. A. (2016) · Drugs & Aging · doi:10.1007/s40266-016-0426-6 · Cited by 127
“To date, interventions that have aimed to improve adherence to prescribed treatments in all patient groups have shown limited effectiveness in improving clinical outcomes and are often too costly or difficult to implement in practice [17].”
BackgroundInfluentialWingfield, T., Tovar, M. A., Huff, D., Boccia, D., Montoya, R., Ramos, E., Datta, S., Saunders, M. J., Lewis, J. J., Gilman, R. H., et al. (2017) · Bulletin of the World Health Organization · doi:10.2471/blt.16.170167 · Cited by 116
Baumel, A., Fleming, T. M., & Schueller, S. M. (2020) · Journal of Medical Internet Research · doi:10.2196/20631 · Cited by 116
“A digital micro intervention for individuals with serious mental illness, for example, might focus on medication adherence [42] in the hopes of reducing clinical symptoms.”
BackgroundKwan, Y. H., Weng, S. D., Loh, D. H. F., Phang, J. K., Oo, L. J. Y., Blalock, D. V., Chew, E., Yap, K. Z., Tan, C. Y. K., Yoon, S., et al. (2020) · Journal of Medical Internet Research · doi:10.2196/19179 · Cited by 126
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A Review of Barriers to Medication Adherence: A Framework for Driving Policy Options
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Interventions for helping people adhere to compression treatments for venous leg ulceration
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Behavior Change Techniques in Apps for Medication Adherence
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“First, there is a paucity of high quality studies in low resource settings despite the higher disease burden for HIV.8 Second, the role of theoretical underpinnings in adherence research for HIV is unclear.”
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“11 Effective interventions focus on self-management, promoting sustained behaviour change.”
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“In addition, patients may not take the drug, or not take as intended (secondary noncompliance), and concordance can be as low as 50% for antidepressants and antihypertensives[4, 43].”
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Adherence in Asthma and COPD: New Strategies for an Old Problem
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“With doctors having limited time and sometimes skill to repeatedly instruct patients to stick to their medications [40], it may make sense to transfer DOT to family members.”
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Digital interventions to improve adherence to maintenance medication in asthma
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“All rights reserved. are detailed in Nieuwlaat et al.,5 and are briefly summarized in the following.”
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“36 Disease therapies and personal demographic factors sometimes were difficult to change, but clinicians and pharmacists play a vitally important role in solving medication problems especially at the first time of taking rheumatic medication.”
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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