Cited by 2,945Medication Adherence and CompliancePharmacy and Medical PracticesPatient Safety and Medication Errors

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 access

Abstract

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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Crossref · 10.1002/14651858.cd000011.pub4

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5 of the 645 references couldn’t be matched to a known paper.

Research works printed but not linked: 33

  1. Chamorro, 2011, Effect of pharmacist involvement in adherence to medications in patients with high to moderate cardiovascular risk (Study EMDADER-CV-INCUMPLIMIENTO), Atencion Primaria, 43, 245
  2. Marquez Contreras, 2004, Efficacy of an intervention to improve treatment compliance in hyperlipidemias, Atencion Primaria, 33, 443
  3. Marquez Contreras, 2007, Therapy compliance in cases of hyperlipaemia, as measured through electronic monitors. Is a reminder calendar to avoid forgetfulness effective?, Atencion Primaria, 39, 661
  4. Strang, 1981, The effects of family therapy on treatment compliance in schizophrenia, Psychopharmacology Bulletin, 17, 87
  5. Yopp, 2004, The Impact of Family Functioning on Treatment Adherence and Metabolic Control for Adolescents with Poorly Controlled T1DM [dissertation]
  6. Barcelo, 2001, An intervention to improve diabetes control in Chile, Revista Panamericana de Salud Publica/Pan American Journal of Public Health, 10, 328
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  8. Birrer, 1984, Hypertension: a double-blind study of compliance in an urban community, Family Practice Research Journal, 3, 251
  9. Bonner, 2002, An individualized intervention to improve asthma management among urban Latino and African-American families, Journal of Asthma, 39, 167, 10.1081/JAS-120002198 · DOI
  10. Bouvy, 2003, Guidance improves compliance. Pharmacist stimulates proper use of loop diuretics in patient with heart failure, Pharmaceutisch Weekblad, 138, 1432
  11. Celik, 1997, Comparison of the clinical efficacy of azithromycin and cerufoxime axetile in the treatment of patients with acute otitis media, Mikrobiyoloji Bulteni, 31, 253
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  14. Leal, 2004, Written information on the use of aerosols in COPD patients. Can we improve their use? [see comment], Atencion Primaria, 33, 6
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  16. Marquez Contreras, 2004, Effectiveness of an intervention to provide information to patients with hypertension as short text messages and reminders sent to their mobile phone (HTA-Alert), Atencion Primaria, 34, 399
  17. Ogedegbe, 2007, An RCT of the effect of motivational interviewing on medication adherence in hypertensive African Americans: rationale and design, Contemporary Clinical Trials, 28, 169, 10.1016/j.cct.2006.04.002 · DOI
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  19. Purcell, 2004, Interventions for seropositive injectors-research and evaluation: an integrated behavioral intervention with HIV-positive injection drug users to address medical care, adherence, and risk reduction, Journal of Acquired Immune Deficiency Syndromes, 37, S110, 10.1097/01.qai.0000140609.44016.c4 · DOI
  20. Razali, 1997, Health education and drug counseling for schizophrenia, International Medical Journal, 4, 187
  21. Rickheim, 2002, Assessment of group versus individual diabetes education: a randomized study, Diabetes Care, 25, 269, 10.2337/diacare.25.2.269 · DOI
  22. Rodriguez, 2003, Effectiveness of a group educational intervention in patients with chronic obstructive pulmonary disease, Enfermeria Clinica, 13, 131
  23. Sanchez, 2002, Treatment of latent tuberculosis infection in injecting drug users co-infected by HIV, Enfermedades Emergentes, 4, 62
  24. Tapanya S A biopsychosocial intervention program to improve medical regimen adherence and glycemic control in type II diabetic patients Dissertation Abstracts International: Section B: the Sciences and Engineering 1997
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  26. Vetter, 1999, Efficacy and safety of once-daily and twice-daily clarithromycin formulations in the treatment of acute exacerbations of chronic bronchitis, Advances in Therapy, 16, 13
  27. Andres Rodriguez, 2007, Assessment of knowledge/compliance in a drug therapy follow-up program involving type 2 diabetic patients in community pharmacy: a randomized study, Pharmaceutical Care Espana, 9, 2
  28. Marquez Contreras, 2000, Therapeutic compliance in hypertension. Trial of two-year health education intervention, Atencion Primaria, 26, 5
  29. Marquez Contreras, 2009, Non-pharmacological intervention as a strategy to improve antihypertensive treatment compliance, Atencion Primaria, 41, 501
  30. Gordis, 1979, Conceptual and methodologic problems in measuring compliance, 23
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  33. Stephenson, 1993, Is this patient taking their medication?, JAMA, 269, 2779, 10.1001/jama.1993.03500210079036 · DOI

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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)
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
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
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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