Medication adherence outcomes of 771 intervention trials: Systematic review and meta-analysis

Conn, Vicki S.; Ruppar, Todd M.

doi:10.1016/j.ypmed.2017.03.008

Cited by 367Medication Adherence and CompliancePharmacy and Medical PracticesPatient Safety and Medication Errors

Medication adherence outcomes of 771 intervention trials: Systematic review and meta-analysis

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Conn, Vicki S., Ruppar, Todd M.·2017·Preventive Medicine

DOI 10.1016/j.ypmed.2017.03.008PMC PMC5467216

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Abstract

Excellent medication adherence contributes to decreases in morbidity, mortality, and health care costs. Although researchers have tested many interventions to increase adherence, results are sometimes conflicting and often unclear. This systematic review applied meta-analytic procedures to integrate primary research that tested medication adherence interventions. Comprehensive searching completed in 2015 located 771 published and unpublished intervention studies with adherence behavior outcomes. Random-effects model analysis calculated standardized mean difference effect sizes. Meta-analytic moderator analyses examined the association between adherence effect sizes and sample, design, and intervention characteristics. Analyses were conducted in 2016. A standardized mean difference effect size of 0.290 comparing treatment and control groups was calculated. Moderator analyses revealed larger effect sizes for habit-based and behavioral-targeted (vs. cognitive-focused) interventions. The most effective interventions were delivered face-to-face, by pharmacists, and administered directly to patients. Effect sizes were smaller in studies with older and homeless participants. Risks of bias were common; effect sizes were significantly lower among studies with masked data collectors and intention-to-treat analyses. The largest effect sizes were reported by studies using medication electronic event monitoring and pill count medication adherence measures. Publication bias was present. This most comprehensive review to date documented that, although interventions can increase adherence, much room remains for improvement. Findings suggest health care providers should focus intervention content on behavioral strategies, especially habit-based interventions, more so than cognitive strategies designed to change knowledge and beliefs.

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Linking medication taking with existing daily routines and using behavioral strategies (eg, prompts to take medication) are the most effective strategies to promote adherence.
“Findings from a meta-analysis of medication adherence interventions among adults demonstrated that linking medication taking with existing daily routines and using behavioral strategies (eg, prompts to take medication) are the most effective strategies to promote adherence [11].”
From Medication Adherence Reminder System for Virtual Home Assistants: Mixed Methods Evaluation Study (2021) · cites this paper as [11]

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Authors: Conn, V. S., & Ruppar, T. M.
Affiliations: University of Missouri (US)
Corresponding author: Conn, Vicki S.
ORCID: Conn, Vicki S.
Ruppar, Todd M.
Venue: Preventive Medicine
Publisher: Elsevier BV
Published: 2017-06
Volume: 99
Pages: 269-276
ISSN: 0091-7435 (ISSN-L)
DOI: 10.1016/j.ypmed.2017.03.008
PMC: PMC5467216
OpenAlex: W2597284704
Cited by: 367
References: 36
Citations by year: 2026: 20 · 2025: 39 · 2024: 41 · 2023: 47 · 2022: 57 · 2021: 55 · 2020: 52 · 2019: 37 · 2018: 11 · 2017: 6 · 2013: 1
FWCI: 4.87
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Preventive Medicine (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (R01NR011990)
Topics: Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
Keywords: medication adherence, adherence interventions, behavioral interventions, cognitive intervention, pill count, publication bias, risk of bias, older adults, homeless patients
MeSH terms: Assessment of Medication Adherence, Humans, Research Design, Bias, Drug Monitoring, Medication Adherence

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Medication adherence outcomes of 771 intervention trials: Systematic review and meta-analysis

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