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A meta-analysis of the association between adherence to drug therapy and mortality
Open accessAbstract
OBJECTIVE: To evaluate the relation between adherence to drug therapy, including placebo, and mortality. DESIGN: Meta-analysis of observational studies. DATA SOURCES: Electronic databases, contact with investigators, and textbooks and reviews on adherence. Review methods Predefined criteria were used to select studies reporting mortality among participants with good and poor adherence to drug therapy. Data were extracted for disease, drug therapy groups, methods for measurement of adherence rate, definition for good adherence, and mortality. RESULTS: Data were available from 21 studies (46,847 participants), including eight studies with placebo arms (19,633 participants). Compared with poor adherence, good adherence was associated with lower mortality (odds ratio 0.56, 95% confidence interval 0.50 to 0.63). Good adherence to placebo was associated with lower mortality (0.56, 0.43 to 0.74), as was good adherence to beneficial drug therapy (0.55, 0.49 to 0.62). Good adherence to harmful drug therapy was associated with increased mortality (2.90, 1.04 to 8.11). CONCLUSION: Good adherence to drug therapy is associated with positive health outcomes. Moreover, the observed association between good adherence to placebo and mortality supports the existence of the "healthy adherer" effect, whereby adherence to drug therapy may be a surrogate marker for overall healthy behaviour.
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“In addition, as adherence with placebo also improves survival, 524 physicians should be aware that adherence to medication may reflect generally better health behaviour.”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [524]
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“For heart failure specifically, numerous studies have shown that medication non-adherence is not only common, but also increases the risk of HF readmission and death [18, 46, 47].”
BackgroundKim, H.-J., Shim, Y. S., Park, K. H., Lee, C., Jung, S., Yoon, S. J., Jeong, S., Jeong, J. H., Choi, S. H., Kim, E., et al. (2021) · Journal of Clinical Neurology · doi:10.3988/jcn.2021.17.3.368 · Cited by 5
NAKAGAWA, C., Yokoyama, S., & Hosomi, K. (2022) · Annals of Pharmacotherapy · doi:10.1177/10600280221126971 · Cited by 5
Tseng, P., Zeng, B., Thompson, T., Stubbs, B., Hsueh, P., Su, K., Chen, Y., Chen, T., Wu, Y., Lin, P., et al. (2023) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13592 · Cited by 5
“8 The placebo effect can generally be de fi ned narrowly or broadly.”
BackgroundResultInfluentialPositive Airway Pressure Therapy Compliance in Patients With Comorbid Insomnia and Sleep Apnea
Bae, M. R., Lee, Y.-H., Lee, S. W., Chung, S., & Chung, Y. (2024) · Clinical and Experimental Otorhinolaryngology · doi:10.21053/ceo.2023.00017 · Cited by 5
“This variation in methods and treatment durations among patients stands in contrast with previous studies that used standardized approaches involving several weeks of treatment and regular visits [9,10,15].”
ResultLin, C., Hsu, T., Tung, Y., Hsiao, F., Chou, S., Lin, Y., Chen, S., & Chu, P. (2024) · Journal of the American Heart Association · doi:10.1161/jaha.123.033780 · Cited by 6
Alessandria, M., Malatesta, G., Palmo, G. D., Cosentino, M., & Donzelli, A. (2025) · F1000Research · doi:10.12688/f1000research.154058.2 · Cited by 5
Martínez, J. W., Perea, J. A. V., Betancur, A. M. Q., Johana Jaramillo, A., Viviana Calderón, F., & M., Á. V. C. (2011) · Revista Facultad Nacional de Salud Pública · doi:10.17533/udea.rfnsp.5246 · Cited by 5
King, M. A., & Pryce, R. (2013) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-013-9893-6 · Cited by 5
“Perceived or genuine lack of benefit is a common cause of non-compliance[14, 23], paradoxically, compliance, even if it is with a placebo, has been shown to improve outcomes[24].”
Background[Extent of platelet aggregation inhibition and clinical events: new evidence with prasugrel].
Abbate, R., Crea, F., Servi, S. D., Filippi, E., Gensini, G. F., Golino, P., & Savonitto, S. (2010) · PubMed · Cited by 5
Simpson, S. H., Mu, L., & Eurich, D. T. (2017) · Annals of Pharmacotherapy · doi:10.1177/1060028017703720 · Cited by 5
“Collectively, these findings support the premise that pharmacy-based inducement programs promote good adherence to prescribed medications, which may indirectly lower a patient’s risk of adverse events.(13,39) There is substantial interest in the role inducement programs may play in community pharmacy practice.”
BackgroundSelf-citationToward Naturalistic Self-Monitoring of Medicine Intake
Curci, S., Mura, A., & Riboni, D. (2017) · Biannual Conference of the Italian SIGCHI Chapter (CHItaly) · doi:10.1145/3125571.3125582 · Cited by 5
“This problem is particularly relevant for patients with chronic illnesses, and can lead to increased use of healthcare services and detriment of life quality [13].”
BackgroundTREATMENT ADHERENCE AS AN ESSENTIAL ELEMENT OF CARDIOVASCULAR DISORDERS MANAGEMENT
Небиеридзе, Д. В., Kamyshova, T. V., Safaryan, A. S., & Sargsyan, V. D. (2017) · CARDIOVASCULAR THERAPY AND PREVENTION · doi:10.15829/1728-8800-2017-6-128-132 · Cited by 5
APPROACHES TO STATIN THERAPY ADHERENCE IMPROVEMENT
Shalnova, S. A., Белов, В. Н., Valiakhmetov, M. N., Veselovskaya, N. G., Voronina, N. V., Дмитриев, А., Ефремова, Е. В., Minushkina, L. O., Naydich, A. М., Pavlova, V. Y., et al. (2018) · CARDIOVASCULAR THERAPY AND PREVENTION · doi:10.15829/1728-8800-2018-2-81-87 · Cited by 5
Prevalence and predictors of being lost to follow-up after transurethral resection of the prostate
Fontana, M., Boeri, L., Gallioli, A., LORENZIS, E. D., Palmisano, F., Zanetti, S. P., Sampogna, G., Albo, G., Longo, F., Gadda, F., et al. (2018) · Scientific Reports · doi:10.1038/s41598-018-24869-z · Cited by 5
Senay, B., Gashu, K. D., Jemere, A. T., & Mekonnen, Z. A. (2019) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-019-0830-z · Cited by 5
Ageev, F. T., Фофанова, Т. В., Смирнова, М. Д., Tkhostov, A. S., Nelubina, A. S., Кузьмина, А. Е., Галанинский, П. В., Kadushina, E. B., Nuraliev, E., & Иосифович, Х. Г. (2012) · CARDIOVASCULAR THERAPY AND PREVENTION · doi:10.15829/1728-8800-2012-4-36-41 · Cited by 5
“Показано, что низкая приверженность терапии является одной из главных причин снижения эффективности терапевтического лечения, ухудшения качества жизни (КЖ) больных и увеличения затрат на лечение [1-3].”
Monitoring and managing medication adherence in community pharmacies in Quebec, Canada
Fénélon-Dimanche, R., Guénette, L., Yousif, A., Lalonde, G., Beauchesne, M.-F., Collin, J., & Blais, L. (2020) · Canadian Pharmacists Journal / Revue des Pharmaciens du Canada · doi:10.1177/1715163520902494 · Cited by 5
“quality of life and increased utilization and cost of health care services.(4-6) Accordingly, it is essential to improve the adherence of patients to their chronic therapeutic regimen.”
BackgroundMedication Nonadherence: Implications for patient health outcomes in pharmacy practice
Al-Temimi, A. A., Krishnan, S., Sandhu, A. K., & Bangash, N. S. A. (2021) · INDONESIAN JOURNAL OF PHARMACY · doi:10.22146/ijp.2236 · Cited by 5
“(2006) found that around a quarter of individuals have poor adherence to the treatment regimen prescribed which is a prominent obstacle to therapeutic outcomes and poses a great challenge to the healthcare providers (Simpson et al., 2006).”
BackgroundAcquadro, M., Marrel, A., Manso-Silván, M. A., Guittet, C., Joukoff, S., & Bertholet‐Thomas, A. (2022) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-022-02294-w · Cited by 5
In search of the best analysis regarding treatment for meningoencephalitis of unknown origin in dogs
Lowrie, M. L. (2023) · Frontiers in Veterinary Science · doi:10.3389/fvets.2022.1062114 · Cited by 5
Mwangi, C., & Mudogo, C. M. (2017) · Journal of Pharmaceutical Care & Health Systems · doi:10.4172/2376-0419.1000179 · Cited by 6
“Conversely, evidence shows that good adherence to drug therapy is associated with positive health outcomes [3].”
BackgroundAdherence in inflammatory bowel disease (IBD): a clinical review
Bager, P., & Jäghult, S. (2019) · Gastrointestinal Nursing · doi:10.12968/gasn.2019.17.6.24 · Cited by 5
Compliance with periodontal maintenance may be associated with increased tooth loss
Hujoel, P. P., Selipsky, H., & Cunha‐Cruz, J. (2006) · Journal of Evidence Based Dental Practice · doi:10.1016/j.jebdp.2006.09.008 · Cited by 5
Metadata
- Authors
- Simpson, S. H., Eurich, D. T., Majumdar, S. R., Padwal, R. S., Tsuyuki, R. T., Varney, J., & Johnson, J. A.
- Affiliations
- University of Alberta (CA)
- Institute of Health Economics (CA)
- Corresponding author
- Simpson, Scot H
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2006-06-21
- Volume
- 333
- Issue
- 7557
- Pages
- 15
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC1488752
- OpenAlex
- W2147982456
- Cited by
- 1,353
- References
- 39
- Citations by year
- 2026: 37 · 2025: 40 · 2024: 57 · 2023: 56 · 2022: 55 · 2021: 83 · 2020: 55 · 2019: 74 · 2018: 90 · 2017: 91 · 2016: 69 · 2015: 71 · 2014: 83 · 2013: 77 · 2012: 86
- FWCI
- 8.08
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- 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 › Opioid Use Disorder Treatment
- Keywords
- medication adherence, pharmacotherapy, mortality, adherence measurement methods
- MeSH terms
- Drug Therapy, Epidemiologic Methods, Humans, Patient Compliance, Prognosis, Randomized Controlled Trials as Topic
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