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

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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 Comprehensive searching completed in 2015 located 771 published and unpublished intervention studies with adherence behavior outcomes.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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Bias in meta-analysis detected by a simple, graphical test
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“On a similar note, a recent meta-analysis on different methods and their effectiveness disclosed the superiority of electronic monitoring compared with other methods (Conn and Ruppar, 2017).”
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Method
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Background
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Result
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BackgroundResult
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BackgroundInfluential
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“Another meta-analysis of adherence interventions in multiple conditions found that interventions targeting the health care provider were less effective than interventions delivered directly to patients (38).”
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Strategies to Improve Adherence to Anti-Hypertensive Medications: a Narrative Review
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Digital interventions to improve adherence to maintenance medication in asthma
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Development of the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) Medication Adherence Scale (PMAS)
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Designing and conducting adaptive trials to evaluate interventions in health services and implementation research: practical considerations
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“22 23”
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Sulkowski, M., Luetkemeyer, A. F., Wyles, D. L., Martorell, C. T., Muir, A. J., Weisberg, I. S., Gordon, S. C., McLain, R. W., & Huhn, G. D. (2020) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15707 · Cited by 25
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“Tailoring of adherence interventions in the literature is, however, currently uncommon—this has been illustrated in a recent meta-analysis of 771 adherence interventions delivered to adult patients (18 years+) which found only nine studies that reported individual-level tailoring [6].”
Background
A machine-learning assisted review of the use of habit formation in medication adherence interventions for long-term conditions
Robinson, L., Arden, M. A., Dawson, S., Walters, S. J., Wildman, M. J., & Stevenson, M. (2022) · Health Psychology Review · doi:10.1080/17437199.2022.2034516 · Cited by 32
“The strategy used was assessed and it was understood that the search conducted by Conn and Ruppar (2017) would be both comprehensive and inclusive enough for the present review.”
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Applying the COM‐B model to patient‐reported barriers to medication adherence in pediatric acute lymphoblastic leukemia
Heneghan, M. B., Hussain, T., Barrera, L., Cai, S. W., Haugen, M., Duff, A., Shoop, J., Morgan, E. R., Rossoff, J. E., Weinstein, J. L., et al. (2020) · Pediatric Blood & Cancer · doi:10.1002/pbc.28216 · Cited by 29
Medication Adherence Measurement in Chronic Diseases: A State-of-the-Art Review of the Literature
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Peer coach delivered storytelling program for diabetes medication adherence: Intervention development and process outcomes
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Understanding Processes, Outcomes, and Contexts in Medication Adherence: The Medication Adherence Context and Outcomes (MACO) Framework
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“To date, interventions to reduce medication nonadherence (ie, improve adherence) are only modestly effective.(2,4,5) In a recent meta-analysis of 771 adherence intervention studies, the overall effect was equivalent to the intervention group taking 7% more of their prescribed doses, compared with controls.”
BackgroundInfluentialSelf-citation
Prevalence and Impact of Having Multiple Barriers to Medication Adherence in Nonadherent Patients With Poorly Controlled Cardiometabolic Disease
Lauffenburger, J. C., Isaac, T., Bhattacharya, R., Sequist, T. D., Gopalakrishnan, C., & Choudhry, N. K. (2019) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2019.10.043 · Cited by 24
“, low perceived need for therapy), (4) lack of medication knowledge/poor health literacy (hereafter referred to as “knowledge”), (5) side effects (e.”
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Behavioral Interventions to Enhance PrEP Uptake Among Black Men Who Have Sex With Men
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Barriers and Solutions to Improve Therapeutic Adherence from the Perspective of Primary Care and Hospital-Based Physicians
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“Overall, simple forgetfulness on the part of the patient is the most frequent cause of poor therapeutic adherence.(8,11,12) Patient adherence with therapeutic regimens may be influenced by subjective beliefs about chronic disease.”
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US Adults Practicing Healthy Lifestyles Before and During COVID-19: Comparative Analysis of National Surveys
Tam, H. L., Chair, S. Y., Leung, I. S. H., Leung, L. Y. L., & Chan, A. S. W. (2023) · JMIR Public Health and Surveillance · doi:10.2196/45697 · Cited by 23
“Health education supported by printed materials, phone calls, and SMS text messaging may improve individuals’ adherence to healthy lifestyles and medical treatments [39-43].”
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Barriers to Medication Adherence in People Living With Epilepsy
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Bibliometric analysis of global publications in medication adherence (1900–2017)
Sweileh, W., Al-Jabi, S. W., Zyoud, S., Shraim, N. Y., Anayah, F., Sawalha, A., & AbuTaha, A. S. (2018) · International Journal of Pharmacy Practice · doi:10.1111/ijpp.12471 · Cited by 20
Patient counselling service with the use of pictograms as the example of pharmacist intervention to improving compliance and medicine safety
Merks, P., Świeczkowski, D., Balcerzak, M., Religioni, U., Drelich, E., Krysiński, J., Hering, D., & Jaguszewski, M. J. (2021) · Cardiology Journal · doi:10.5603/cj.a2021.0022 · Cited by 21
“The results of a recently published analysis of 771 studies aiming to improve therapeutic adherence showed that healthcare professionals should focus more on behavioral interventions, especially those based on the development of drug use habits, than on cognitive strategies to change the knowledge and beliefs of patie…”
Background
Effectiveness of nurse‐led interventions on medication adherence in adults taking medication for metabolic syndrome: A systematic review and meta‐analysis
Kim, C., Kim, M., Lee, G., Park, E., & Schlenk, E. A. (2022) · Journal of Clinical Nursing · doi:10.1111/jocn.16589 · Cited by 27
A pilot study of the S-MAP (Solutions for Medications Adherence Problems) intervention for older adults prescribed polypharmacy in primary care: study protocol
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Qualitative Exploration of Barriers to Statin Adherence and Lipid Control
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van de Vijver, I., Brinkhof, L. P., & de Wit, S. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1140366 · Cited by 20
“Indeed, a meta-analysis of interventions targeted at increasing medication adherence showed the largest effect sizes for behaviorally-focused, habit-based approaches (Conn and Ruppar, 2017).”
Background
When Is Forgetting Not Forgetting? A Discursive Analysis of Differences in Forgetting Talk Between Adults With Cystic Fibrosis With Different Levels of Adherence to Nebulizer Treatments
Drabble, S. J., O’Cathain, A., Arden, M. A., Hutchings, M., Beever, D., & Wildman, M. J. (2019) · Qualitative Health Research · doi:10.1177/1049732319856580 · Cited by 20
“Low adherence to treatment is a global health problem that has been linked to poorer outcomes such as increased morbidity, mortality, and other costs across a range of clinical conditions (Conn & Ruppar, 2017), including chronic health conditions such as cystic fibrosis (CF).”
Background
Medication Adherence Aligns with Age and a Behavioral Checklist but Not Symptoms or Quality of Life for Patients with Eosinophilic Esophagitis
Mehta, P., Pan, Z., Skirka, S., Kwan, B. M., & Menard-Katcher, C. D. (2021) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2021.03.047 · Cited by 19
Assisting older adults with medication reminders through an audio-based activity recognition system
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“Во-вторых, сам факт участия в исследовании может повлиять на поведение участников [13], в частности, привести к увеличению комплаентности [14], что само по себе повышает эффективность изучаемой терапии [15].”
Personalised management and supporting individuals to live with their asthma in a primary care setting
Pinnock, H., Noble, M., Lo, D. K. H., McClatchey, K., Marsh, V., & Hui, C. Y. (2023) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2023.2241357 · Cited by 20
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Toward digital-based interventions for medication adherence and safety
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Artificial Intelligence to Diagnose Complications of Diabetes
Ayers, A. T., Ho, C., Kerr, D. E., Cichosz, S. L., Mathioudakis, N. N., Wang, M., Najafi, B., Moon, S. J., Pandey, A., & Klonoff, D. C. (2024) · Journal of Diabetes Science and Technology · doi:10.1177/19322968241287773 · Cited by 28
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“However, only moderate improvements in adherence have been achieved, at best.(28,29) Fortunately, digital technologies have emerged in recent years as increasingly popular and potentially powerful tools to provide individualized support to change health behaviors.”
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Exploring behavioral intervention components for African American/Black and Latino persons living with HIV with non-suppressed HIV viral load in the United States: a qualitative study
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“Habits were one means of addressing the cognitive biases that reduce HIV medication adherence to thereby improve adherence by making it automatic with less cognitive effort [56].”
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Persistent Adherence to Airway Clearance Therapy in Adults With Cystic Fibrosis
Sherman, A. C., Simonton-Atchley, S., Campbell, D., Reddy, R. M., O’Brien, C. E., Guinee, B., Wagner, L. D., & ANDERSON, P. J. (2019) · Respiratory Care · doi:10.4187/respcare.06500 · Cited by 16

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
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
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, 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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