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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In the citing paper
“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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“tend to meet with more success.(42,43) A recent nationwide randomized trial in individuals with myocardial infarction that incorporated electronic pill bottles, lottery incentives, and social support without direct involvement of physicians or pharmacists did not improve medication adherence or reduce cardio vascular…”
BackgroundWilliams, A. F., Manias, E., & Walker, R. G. (2008) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2008.07.002 · Cited by 81
Adherence to Growth Hormone Therapy: Results of a Multicenter Study
Aydın, B. K., Aycan, Z., Şıklar, Z., Berberoğlu, M., Öçal, G., Çetinkaya, S. Ç., Baş, V. N., Kendırcı, H. N. P., Çetinkaya, E., Darcan, Ş., et al. (2013) · Endocrine Practice · doi:10.4158/ep13194.or · Cited by 86
Measuring therapeutic adherence in systemic lupus erythematosus with electronic monitoring
Marengo, M. F., Waimann, C., de Achaval, S., Zhang, H., García-González, A., Richardson, M., Reveille, J. D., & Suarez-Almazor, M. E. (2012) · Lupus · doi:10.1177/0961203312447868 · Cited by 83
Covic, A. C., & Rastogi, A. (2013) · BMC Nephrology · doi:10.1186/1471-2369-14-153 · Cited by 85
How to Screen for Non-Adherence to Antihypertensive Therapy
Gupta, P., Patel, P., Horne, R., Buchanan, H., Williams, B., & Tomaszewski, M. (2016) · Current Hypertension Reports · doi:10.1007/s11906-016-0697-7 · Cited by 84
Wright, E. A., Darer, J. D., Tang, X., Thompson, J., Tusing, L. D., Fossa, A. J., Delbanco, T., Ngo, L. H., & Walker, J. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.4872 · Cited by 83
“Improving adherence has long been a challenge for both clinicians and patients; although some interventions targeting the patient, provider, and the health delivery system have demonstrated higher adherence, they are often limited to defined diseases or patient populations, are frequently costly, and the results from…”
BackgroundBobrow, K., Brennan, T., Springer, D., Levitt, N. S., Rayner, B., Namane, M., Yu, L.-M., Tarassenko, L., & Farmer, A. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-28 · Cited by 83
Adherence enhancing interventions for oral anticancer agents: A systematic review
Mathes, T., Antoine, S., Pieper, D., & Eikermann, M. (2013) · Cancer Treatment Reviews · doi:10.1016/j.ctrv.2013.07.004 · Cited by 83
Adherence to Antihypertensive Medication in Older Adults With Hypertension
Lo, S. H. S., Chau, J. P. C., Woo, J., Thompson, D. R., & Choi, K. C. (2015) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000000251 · Cited by 83
“assume active roles in compromising and executing the therapeutic medication regimen.(10) In general, factors in-”
BackgroundGleeson, T., Iversen, M. D., Avorn, J., Brookhart, A. M., Katz, J. N., Losina, E., May, F. W., Patrick, A. R., Shrank, W. H., & Solomon, D. H. (2009) · Osteoporosis International · doi:10.1007/s00198-009-0976-0 · Cited by 80
Hiligsmann, M., Salas, M., Hughes, D. A., Manias, E., Gwadry-Sridhar, F. H., Linck, P., & Cowell, W. (2013) · Osteoporosis International · doi:10.1007/s00198-013-2364-z · Cited by 83
Paudyal, V., MacLure, K., Buchanan, C., Wilson, L., Macleod, J., & Stewart, D. C. (2017) · Public Health · doi:10.1016/j.puhe.2017.03.002 · Cited by 83
MacDonald, L., Chapman, S., Syrett, M., Bowskill, R., & Horne, R. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.01.002 · Cited by 80
Practical Considerations for Using Novel Oral Anticoagulants in Patients With Atrial Fibrillation
Savelieva, I., & Camm, A. J. (2013) · Clinical Cardiology · doi:10.1002/clc.22204 · Cited by 84
Improving diabetes medication adherence: successful, scalable interventions
Zullig, L. L., Gellad, W. F., Moaddeb, J., Crowley, M. J., Shrank, W. H., Trygstad, T. K., Liu, L., Bosworth, H. B., Granger, B. B., & Granger, C. B. (2015) · Patient Preference and Adherence · doi:10.2147/ppa.s69651 · Cited by 82
Smith, C. E., Ngo, T. D., Gold, J., Edwards, P. J., Vannak, U., Sokhey, L., Machiyama, K., Slaymaker, E., Warnock, R., McCarthy, O., et al. (2015) · Bulletin of the World Health Organization · doi:10.2471/blt.15.160267 · Cited by 82
Concept Analysis of Adherence in the Context of Cardiovascular Risk Reduction
Cohen, S. M. (2009) · Nursing Forum · doi:10.1111/j.1744-6198.2009.00124.x · Cited by 83
Pierobon, A., Bottelli, E. S., Ranzini, L., Bruschi, C., Maestri, R., Bertolotti, G., Sommaruga, M., Torlaschi, V., Callegari, S., & Giardini, A. (2017) · International Journal of COPD · doi:10.2147/copd.s133586 · Cited by 82
“Moreover, as described in the literature, most of the tools used to assess adherence and the interventions to enhance medication adherence do not focus on behavioral prescriptions, but focus mainly on taking or not taking drugs.(7) To the best of our knowledge, there is a lack of scientific literature describing simul…”
Kassavou, A., & Sutton, S. R. (2017) · Health Psychology Review · doi:10.1080/17437199.2017.1365617 · Cited by 85
“However, current methods to increase adherence are complex and ineffective (Nieuwlaat et al., 2014).”
D’Antoni, D., Smith, L., Auyeung, V., & Weinman, J. A. (2017) · Environmental Health · doi:10.1186/s12940-017-0307-4 · Cited by 83
“[52]), and in particular in relation to the adoption of protective behaviour during”
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Mittler, J., Martsolf, G. R., Telenko, S., & Scanlon, D. P. (2013) · Milbank Quarterly · doi:10.1111/milq.12002 · Cited by 86
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A study of adherence to antibiotic treatment in ambulatory respiratory infections
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Nonadherence in difficult asthma – facts, myths, and a time to act
Heaney, L. G., & Lindsay (2013) · Patient Preference and Adherence · doi:10.2147/ppa.s38208 · Cited by 81
Denhaerynck, K., Berben, L., Dobbels, F., Russell, C. L., Crespo‐Leiro, M. G., Poncelet, A. J., & Geest, S. D. (2017) · American Journal of Transplantation · doi:10.1111/ajt.14611 · Cited by 80
Combating inappropriate use of medicines
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Multimedia educational interventions for consumers about prescribed and over-the-counter medications
Ciciriello, S., Johnston, R. V., Osborne, R. H., Wicks, I. P., deKroo, T., Clerehan, R., O'Neill, C., & Buchbinder, R. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008416.pub2 · Cited by 80
Vasbinder, E. C., Goossens, L. M. A., Mölken, M. R., de Winter, B. C. M., van Dijk, L., Vulto, A. G., Blankman, E. I. M., Dahhan, N., Schie, M. T. M. V., Versteegh, F. G. A., et al. (2016) · European Respiratory Journal · doi:10.1183/13993003.01698-2015 · Cited by 80
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Real-time feedback for improving medication taking
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Adherence to prophylactic asthma medication: Habit strength and cognitions
Bolman, C. A. W., Arwert, T. G., & Völlink, T. (2010) · Heart & Lung · doi:10.1016/j.hrtlng.2010.02.003 · Cited by 79
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Using qualitative synthesis to explore heterogeneity of complex interventions
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Bediang, G., Stoll, B., Elia, N., Abena, J.-L., & Geissbühler, A. (2018) · BMC Public Health · doi:10.1186/s12889-018-5502-x · Cited by 79
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“medicines adherence) [15] and have shown benefits in clinical, lifestyle and psychosocial outcomes.”
BackgroundFour levels of outcomes of information‐seeking: A mixed methods study in primary health care
Pluye, P., Grad, R. M., Repchinsky, C. A., Jovaisas, B., Johnson‐Lafleur, J., Carrier, M., Granikov, V., Farrell, B. J., Rodríguez, C., Bartlett, G., et al. (2012) · Journal of the American Society for Information Science and Technology · doi:10.1002/asi.22793 · Cited by 80
The potential impact of pharmacogenetic testing on medication adherence
Haga, S. B., & LaPointe, N. M. A. (2013) · The Pharmacogenomics Journal · doi:10.1038/tpj.2013.33 · Cited by 77
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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