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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Homework in Cognitive Behavioral Therapy
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The development of the ProMAS: a Probabilistic Medication Adherence Scale
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“A recent Cochrane Review of adherence studies across chronic conditions found only a small number of trials improved bothmedication adherence and clinical outcomes [36].”
BackgroundPresseau, J., Schwalm, J.-D., Grimshaw, J., Witteman, H. O., Natarajan, M. K., Linklater, S., Sullivan, K., & Ivers, N. M. (2016) · Psychology and Health · doi:10.1080/08870446.2016.1260724 · Cited by 62
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“Many studies on the impact of patient support methods have been small in size and produced mixed results [35, 36].”
ResultImproving adherence to cardiovascular disease medications with information technology.
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“A recent systematic review of interventions for adherence found that the most frequently targeted conditions were HIV, depression, chronic obstructive pulmonary disease, cardiovascular disease, hypertension, and diabetes [18].”
BackgroundTaking Responsibility for Responsibility
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“Moreover, when disease arises, there is usually a great deal we can do to help to manage it, and patients fail surprisingly often to do these things—only about half of all prescribed doses of medication are taken by patients, for instance (Nieuwlaat et al., 2014).”
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“Medication adherence can be addressed in many ways, including automatic reminders, reminder packaging, medication boxes, device aids, counselling, telephone support, patient education, etc, or a combination of those [2,33-35].”
Patient-Reported Compliance in older age patients with chronic heart failure
Jankowska‐Polańska, B., Świątoniowska-Lonc, N., Sławuta, A., Krówczyńska, D., Dudek, K. D., & Mazur, G. J. (2020) · PLoS ONE · doi:10.1371/journal.pone.0231076 · Cited by 60
“The present study has demonstrated that nearly 60% of patients reported that they always took their medication as prescribed, which corroborates findings presented in the literature [22,23].”
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“For example, non-adherence to medication ranges from 25 to 50 per cent and is associated with more hospital admissions and medical complications (Beck et al., 1985; Claxton et al., 2001; Haynes et al., 2002; Nieuwlaat et al., 2014; Payero et al., 2014; Sokol et al., 2005).”
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“A patient’s adherence can vary from 0, which means that the patient does not comply with the recommendations, to 100%, which means that the patient complies with the recommendations [11,12].”
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2015 ACC/AHA Focused Update of Secondary Prevention Lipid Performance Measures
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“Ensuring adherence is not simply a matter of writing a prescription and advising the patient to take the medication (42).”
BackgroundInfluentialStrategies to Predict, Measure, and Improve Psychosocial Treatment Adherence
Gearing, R. E., Townsend, L. D., Elkins, J., El‐Bassel, N., & Osterberg, L. G. (2013) · Harvard Review of Psychiatry · doi:10.1097/hrp.10.1097/hrp.0000000000000005 · Cited by 72
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“Systematic reviews suggest that, overall, the full benefits of medical treatments for chronic medical conditions are not obtained as most approaches intended to improve patient adherence to medication are complex and not so effective.(46) Reducing poor medication adherence by extending the dosing cycle is a more speci…”
Medication adherence and treatment-resistant hypertension: a review
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“Two recent systematic reviews of interventions to improve adherence to medications prescribed for chronic conditions found mixed results [21–23].”
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“However, failure to target interventions to nonadherent patients and to tailor the intervention to individual patient barriers to adherence may have undermined the success of interventions in clinical settings.(7,8) In a recent pragmatic trial of reminder devices, one potential reason for the absence of improvements i…”
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“We used trials included in the latest version of a Cochrane review on interventions for enhancing medication therapy adherence [12], but updated their search from 2013 to 2015.”
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“Previous studies showed that multifaceted mHealth interventions are more effective in improving medication adherence than interventions targeting only 1 aspect of nonadherent behavior [4,12-14] because medication adherence is a complex behavior affected by many factors [15].”
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“designed, feasible and long-term effect interventions intended to enhance patient adherence (56).”
BackgroundArdito, V., Golubev, G., Ciani, O., & Tarricone, R. (2023) · JMIR Cancer · doi:10.2196/42092 · Cited by 61
“In addition, apps have been shown to increase medication adherence, leading to reduced adverse events and increased quality of life [13,14].”
BackgroundCutrona, S. L., Choudhry, N. K., Stedman, M. R., Servi, A. D., Liberman, J. N., Brennan, T. A., Fischer, M. A., Brookhart, M. A., & Shrank, W. H. (2010) · Journal of General Internal Medicine · doi:10.1007/s11606-010-1387-9 · Cited by 58
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“Increasing perceived necessity has previously been suggested as an intervention to improve adherence in other diseases, as has psychological therapy such as cognitive behaviour therapy and motivational psychology.(38) The finding that more severe disease was associated with reduced adherence contradicts a recent syste…”
Multifaceted Prospective Memory Intervention to Improve Medication Adherence
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“Medication adherence is critically important, yet typical adherence rates for prescribed medications are approximately 50%.(1) These rates are particularly low when medications are prescribed for chronic and asymptomatic conditions such as hypertension.”
BackgroundImproving Patient's Primary Medication Adherence
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“The evidence supporting adherence-promoting interventions over the past decade has been weak.(51) Moreover, many of these interventions are complex and labor-intensive and may therefore not be feasible in clinical settings in the current era of costcontainment.”
BackgroundOlder adults' medication management in the home: How can robots help?
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“Systematic reviews have repeatedly concluded that existing nonadherence interventions have, at best, a modest impact on nonadherence and related health outcomes [11,13].”
BackgroundTailored Interventions to Improve Medication Adherence for Cardiovascular Diseases
Xu, H., Yu, Y., Zhang, Q., Hu, H., & Li, M. (2020) · Frontiers in Pharmacology · doi:10.3389/fphar.2020.510339 · Cited by 58
“In particular, clinical outcomes have been considered standards of high-quality medication adherence interventions (Nieuwlaat et al., 2014).”
BackgroundCost-Utility Analysis of Glaucoma Medication Adherence
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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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