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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“…other studies or reviews Other Cochrane systematic reviews have examined interventions for enhancing general self-administered medication adherence (Nieuwlaat 2014), interventions delivered by mobile phone specific to improving contraceptive use (Smith 2015a), and educational interventions aimed…”
BackgroundPreti, M., Joura, E. A., Vieira‐Baptista, P., van Beurden, M., Bevilacqua, F., Bleeker, M. C. G., Bornstein, J., Carcopino, X., Chargari, C., Cruickshank, M. E., et al. (2022) · Journal of Lower Genital Tract Disease · doi:10.1097/lgt.0000000000000683 · Cited by 52
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“A Cochrane review found insufficient evidence regarding the effectiveness of mobile text messaging and internet-based interventions in promoting medication adherence [3].”
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“Yet, evidence to support the best way to maximize adherence is inconclusive: a 2008 Cochrane review of the literature [6] found that quantitative analyses could not be performed due to the large differences between published studies in terms of medical condition, patient population, intervention, measures of adherence…”
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Rodrigues, R., Poongulali, S., Balaji, K., Atkins, S., Ashorn, P., & Costa, A. D. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-007574 · Cited by 59
“28 Effective adherence support interventions need family or peer support, counselling and daily treatment support reflecting their complexity.(28) Participants also reported feeling the ‘concern’ of their healthcare providers towards their health, more so with the voice calls than with the SMSs.”
BackgroundInvolved, inputting or informing: “Shared” decision making in adult mental health care
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“The conditions most frequently studied have been HIV/AIDS, tuberculosis, epilepsy, psychiatric disorders, asthma, chronic obstructive pulmonary disease, cardiovascular disease or cardiovascular risk, hypertension, and diabetes [21,23].”
BackgroundTemporal stability of beliefs about medicines: Implications for optimising adherence
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“The average level of medication adherence among patients with chronic diseases in developed countries is only 50% [7, 9, 10].”
BackgroundMunkhaugen, J., Ruddox, V. D. B., Halvorsen, S., Dammen, T., Fagerland, M. W., Hernæs, K. H., Vethe, N. T., Prescott, E., Jensen, S. E., Rødevand, O., et al. (2018) · American Heart Journal · doi:10.1016/j.ahj.2018.10.005 · Cited by 51
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“The most effective strategies for improving adherence were complex including combinations of more instructions and health education for patients, disease and treatment-specific adherence counselling, automated and in-person telephone follow-up, and reminders (for pills, appointments, and prescription refills) [22].”
BackgroundFactors affecting medication adherence trajectories for patients with heart failure.
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“However, the effects were inconsistent and varied by study design and country, which has also been found in a similar review.(67) Many interventions in this review relied on existing healthcare interventions and resources while targeting local factors that affected medication adherence.”
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On behalf of the OMERACT-Adherence Group, Kelly, A., Tong, A., Tymms, K., MARCH, L. M., Craig, J. C., Vera, M. A. D., Evans, V., Hassett, G., Toupin‐April, K., et al. (2018) · Trials · doi:10.1186/s13063-018-2565-z · Cited by 53
“Yet few interventions have demonstrated meaningful improvements in either medication adherence or clinical outcomes across medical specialties [20, 21].”
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Zullig, L. L., Blalock, D. V., Dougherty, S., Henderson, R. R., Ha, C. C., Oakes, M. M., & Bosworth, H. B. (2018) · Patient Preference and Adherence · doi:10.2147/ppa.s165404 · Cited by 50
“10,11 Furthermore, as indicated by a recent Cochrane review analysis, 12 research often does not consider nonadherent individuals; in order to obtain clinical benefits from effective adherence interventions, researchers need to focus on the inclusion of nonadherent patients.”
Long, H. A., Bartlett, Y. K., Farmer, A. A., & French, D. (2018) · Journal of Medical Internet Research · doi:10.2196/10421 · Cited by 49
“Given the lack of effectiveness of existing interventions [13], there is a need to determine promising novel intervention content for the future.”
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Geramita, E. M., Dabbs, A. D., DiMartini, A. F., Pilewski, J. M., Switzer, G. E., Posluszny, D. M., Myaskovsky, L., & Dew, M. A. (2019) · Transplantation · doi:10.1097/tp.0000000000002872 · Cited by 50
“Thus, as noted in the adherence literature in chronic disease, there is no permanent “cure” for nonadherence that would allow intervention activities to end once adherence is achieved.(57) Instead, interventions, including mHealth interventions, must become a permanent part of patients’ lives for as long as they are e…”
BackgroundResultReminder systems and late patient tracers in the diagnosis and management of tuberculosis
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Persistence as a Robust Indicator of Medication Adherence-Related Quality and Performance
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“This information could be shared across the primary and secondary care interface, supporting multidisciplinary and multifaceted interventions, which are known to be more effective [37,38].”
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Kardas, P. (2023) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2023.10.012 · Cited by 49
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Health Technology Assessment in Osteoporosis
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“This discrepancy in research evidence regarding medication adherence in Greece, needs further exploration because poor adherence has not only been related with poorer patient outcomes, illness complications, and higher morbidity [5] [12] but poor adherence can also cause direct and indirect increases in costs to the h…”
BackgroundThe Intentional Non-Adherence Scale (INAS): Initial development and validation
Weinman, J. A., Graham, S., Canfield, M., Kleinstäuber, M., Perera, A. I., Dalbeth, N., & Petrie, K. J. (2018) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2018.10.010 · Cited by 50
“Numerous interventions have been developed for facilitating medicines adherence (3,4) but sub-optimal adherence continues to be a massive problem in healthcare (1,5).”
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“Adequate adherence to the diuretic regimen was considered a minimum of 80% of prescribed doses taken.(43) Each behavior was scored as adherent or nonadherent at each measurement interval, for a maximum of 18 separate ratings for each person (3 behaviors, 6 time periods).”
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“Finding a gold standard to measure the rate of non-adherence or simply a common approach to address the problem is difficult [12].”
BackgroundInterventions to increase adherence to medications for tobacco dependence
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“Perhaps more importantly, we should routinely employ effective patient-centered interventions to improve medication adherence [31, 32].”
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Preclinical modeling in depression and anxiety: Current challenges and future research directions
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“Educational interventions are also a common long-term strategy to improve adherence to medications [2,43].”
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“As in other condition areas, these standardized tools and assessments can be modified to provide targeted feedback for both patients and providers [59,78,83 – 85].”
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“herence [22, 25].”
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“Errors with little or no potential for harm, such as an inadequate dosing frequency and a complex therapy, are likely to reduce patient adherence and are therefore worthy of identification, resolution and prevention [44].”
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Health locus of control: Its relationship with medication adherence and medication wastage
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“A systematic review of the literature on interventions for enhancing medication adherence concluded that most interventions to enhance adherence in chronic conditions resulted to be rather “complex and not very effective”, and suggests more innovative approaches for researching ways to enhance medication adherence.(5)…”
BackgroundPerceptions and practices addressing diversion among US buprenorphine prescribers
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Adherence to Cholinesterase Inhibitors in Alzheimer's Disease: A Review
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The process of medication management for older adults with dementia
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The Role of Depression in Medication Adherence Among Heart Failure Patients
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2015 ACC/AHA Focused Update of Secondary Prevention Lipid Performance Measures
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Complementary Tools to Empower and Sustain Behavior Change
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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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