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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“Patients with chronic conditions have been reported to take only half of their prescribed medications [11,27].”
BackgroundAccountability: a missing construct in models of adherence behavior and in clinical practice
Oussedik, E., Foy, C. G., Masicampo, E. J., Kammrath, L. K., Anderson, R. E., & Feldman, S. R. (2017) · Patient Preference and Adherence · doi:10.2147/ppa.s135895 · Cited by 72
Poverty, Transportation Access, and Medication Nonadherence
Hensley, C. G., Heaton, P. C., Kahn, R. S., Luder, H. R., Frede, S. M., & Beck, A. F. (2018) · PEDIATRICS · doi:10.1542/peds.2017-3402 · Cited by 67
Schoenthaler, A., Leon, M., Butler, M. J., Steinhaeuser, K., & Wardzinski, W. (2020) · JMIR mhealth and uhealth · doi:10.2196/17135 · Cited by 67
“On the basis of meta-analyses of adherence interventions, the sample size was calculated using a moderate change in adherence (0.49 between-group difference) [43] as the effect size, power of .80, and significance level of α of .05.”
InfluentialPharmacist‐led interventions to improve medication adherence in older adults: A meta‐analysis
Marcum, Z. A., Jiang, S., Bacci, J. L., & Ruppar, T. M. (2021) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17373 · Cited by 82
“Medication nonadherence is a common and costly global healthcare problem.(1,2) In the United States alone, it is estimated that medication nonadherence causes nearly 125,000 deaths per year.”
BackgroundFarmer, A. A., Hardeman, W., Hughes, D. A., Prevost, A. T., Kim, Y., Craven, A., Oke, J. L., Boase, S., Selwood, M. P., Kellar, I., et al. (2012) · BMC Family Practice · doi:10.1186/1471-2296-13-30 · Cited by 73
Kennedy, J. J., & Morgan, S. (2009) · Clinical Therapeutics · doi:10.1016/j.clinthera.2009.01.006 · Cited by 67
Comprehensive Medication Management and Medication Adherence for Chronic Conditions
Brummel, A. R., & Carlson, A. M. (2016) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2016.22.1.56 · Cited by 67
Transforming our health care system: ten priorities for commissioners
Imison, C. (2015) · Cited by 67
Easthall, C., & Barnett, N. L. (2017) · Pharmacy · doi:10.3390/pharmacy5030050 · Cited by 67
“The most recent Cochrane review of medicine adherence highlights a paucity of effective adherence interventions and lack of progress in the field; interventions which improve adherence do so by marginal gains at best and improvements in both adherence and clinical outcomes are rare [6].”
BackgroundTemporal effectiveness of interventions to improve medication adherence: a network meta-analysis
Wiecek, E., Tonin, F. S., Torres-Robles, A., Benrimoj, S. I., Fernandez-Llimos, F., & Garcia-Cardenas, V. (2019) · PLOS ONE · doi:10.1371/journal.pone.0213432 · Cited by 67
Chan, A. H. Y., Cooper, V., Lycett, H., & Horne, R. (2020) · Frontiers in Pharmacology · doi:10.3389/fphar.2020.00572 · Cited by 67
Zaugg, V., Korb-Savoldelli, V., Durieux, P., & Sabatier, B. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012042.pub2 · Cited by 61
Improving Medication Adherence in Chronic Pediatric Health Conditions: A Focus on ADHD in Youth
Chacko, A., H. Newcorn, J., Feirsen, N., & Z. Uderman, J. (2010) · Current Pharmaceutical Design · doi:10.2174/138161210791959908 · Cited by 66
Medication management support in diabetes: a systematic assessment of diabetes self-management apps
Huang, Z., Lum, E., Jimenez, G., Semwal, M., Sloot, P., & Car, J. (2019) · BMC Medicine · doi:10.1186/s12916-019-1362-1 · Cited by 66
“These strategies include education on disease management, simplification of dosing regimen, counselling, reminders, or a combination of these methods [5, 6].”
BackgroundAssessment of Beliefs and Attitudes About Statins Posted on Twitter
Golder, S., O’Connor, K., Hennessy, S., Gross, R., & Gonzalez‐Hernandez, G. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.8953 · Cited by 66
Torres-Robles, A., Benrimoj, S. I., Gastelurrutia, M. Á., Martínez, F. M., Zorrilla, T. P., Pérez-Escamilla, B., Rogers, K. D., Valverde-Merino, M. I., Doval, R. V., & García‐Cárdenas, V. (2021) · BMJ Quality & Safety · doi:10.1136/bmjqs-2020-011671 · Cited by 78
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Primary non-adherence to bisphosphonates in an integrated healthcare setting
Reynolds, K., Muntner, P., Cheetham, T. C., Harrison, T. N., Morisky, D., Silverman, S. L., Gold, D. T., Vansomphone, S. S., Wei, R. X., & O’Malley, C. D. (2013) · Osteoporosis International · doi:10.1007/s00198-013-2326-5 · Cited by 66
Müller, S., Kohlmann, T., & Wilke, T. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-0809-0 · Cited by 68
“But there is an obvious lack of efficacy of existing adherence interventions/programs [2,9,10], especially with regards to improvements of long-term adherence and of associated clinical outcomes [11].”
BackgroundStockl, K. M., Shin, J. S., Lew, H. C., Zakharyan, A., Harada, A. S. M., Solow, B. K., & Curtis, B. S. (2010) · Journal of Managed Care Pharmacy · doi:10.18553/jmcp.2010.16.8.593 · Cited by 66
Improving the quality of care in general practice
Goodwin, N., Dixon, A. L., Poole, T.-L., & Raleigh, V. S. (2011) · Cited by 66
Improving Adherence With Medication
Matthes, J., & Albus, C. (2014) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2014.0041 · Cited by 67
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Personalised medicine: The cognitive side of patients
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“These attributes are important, not only just because people prefer to be treated by clinicians who are good listeners and good at informing, advising, and educating them, but also this type of care may contribute to better health outcomes [3], to a higher adherence to treatment recommendations [4], and to increased t…”
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Self-management skills in adolescents with chronic rheumatic disease: A cross-sectional survey
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A Smartphone-based Medication Self-management System with Real-time Medication Monitoring
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Elliott, R. A., Tanajewski, Ł., Gkountouras, G., Avery, A. J., Barber, N., Mehta, R. L., Boyd, M., Latif, A., Chuter, A., & Waring, J. J. (2017) · PharmacoEconomics · doi:10.1007/s40273-017-0554-9 · Cited by 66
“recent Cochrane review as ‘‘mostly complex and not very effective’’, and in need of better design [58].”
BackgroundUsing pharmacokinetics to individualize hemophilia therapy
Iorio, A. (2017) · Hematology · doi:10.1182/asheducation-2017.1.595 · Cited by 63
“Behavioral theory supports the construct that deeper knowledge of the physiopathology of disease and the mechanism of action of treatment has a positive effect on compliance, adherence, and persistence.(24)”
MethodSelf-citationImproving medication adherence in patients with cardiovascular disease: a systematic review
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“This lack of association, also frequently observed in other studies (29), could lie on the usual limitations of the questionnaires used to determine the selfreported adherence, less reliable than other tools, as for example electronic adherence.”
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Cong, L., Ren, Y., Hou, T., Han, X., Dong, Y., Wang, Y., Zhang, Q., Liu, R., Xu, S., Wang, L., et al. (2020) · Frontiers in Pharmacology · doi:10.3389/fphar.2020.608136 · Cited by 64
Interventions to improve adherence to inhaled steroids for asthma
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Glycemic control in type 2 diabetes: from medication nonadherence to residual vascular risk
Giugliano, D., Maiorino, M. I., Bellastella, G., & Esposito, K. (2018) · Endocrine · doi:10.1007/s12020-017-1517-9 · Cited by 62
Factor structure and longitudinal invariance of the Medical Adherence Report Scale-Asthma
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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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