Background
People who are prescribed self-administered medications typically take less than half the prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications, but also might increase their adverse effects.

Objectives
To update a review summarizing the results of randomized controlled trials (RCTs) of interventions to help patients follow prescriptions for medications for medical problems, including mental disorders but not addictions.

Search methods
We updated searches of The Cochrane Library, MEDLINE, CINAHL, EMBASE, International Pharmaceutical Abstracts (IPA), PsycINFO (all via OVID) and Sociological Abstracts (via CSA) in January 2007 with no language restriction. We also reviewed bibliographies in articles on patient adherence and articles in our personal collections, and contacted authors of relevant original and review articles.

Selection criteria
Articles were selected if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications, measuring both medication adherence and treatment 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 initial findings.

Data collection and analysis
Study design features, interventions and controls, and results were extracted by one review author and confirmed by at least one other review author. We extracted adherence rates and their measures of variance for all methods of measuring adherence in each study, and all outcome rates and their measures of variance for each study group, as well as levels of statistical significance for differences between study groups, consulting authors and verifying or correcting analyses as needed. The studies differed widely according to medical condition, patient population, intervention, measures of adherence, and clinical outcomes. Therefore, we did not feel that quantitative analysis was scientifically justified; rather, we conducted a qualitative analysis.

Main results
For short-term treatments, four of ten interventions reported in nine RCTs showed an effect on both adherence and at least one clinical outcome, while one intervention reported in one RCT significantly improved patient adherence, but did not enhance the clinical outcome. For long-term treatments, 36 of 83 interventions reported in 70 RCTs were associated with improvements in adherence, but only 25 interventions led to improvement in at least one treatment outcome. Almost all of the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up, and supportive care. Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes.

Authors' conclusions
For short-term treatments several quite simple interventions increased adherence and improved patient outcomes, but the effects were inconsistent from study to study with less than half of studies showing benefits. Current methods of improving adherence for chronic health problems are mostly complex and not very effective, so that the full benefits of treatment cannot be realized. High priority should be given to fundamental and applied research concerning innovations to assist patients to follow medication prescriptions for long-term medical disorders.

Interventions for enhancing medication adherence.

Objective
To explore and evaluate the most common factors causing therapeutic non-compliance.

/pdf/factors-affecting-therapeutic-compliance-a-review-from-the-2dvyfkvlx9.pdf

Factors affecting therapeutic compliance: A review from the patient's perspective.

Behavior change is a critical part of effective health care. The final decision to become healthier, however, is that of the patient and not the practitioner. Anyone who has treated patients knows ...

Motivational Interviewing in Health Care: Helping Patients Change Behavior

Patients' beliefs about treatment influence treatment engagement and adherence. The Necessity-Concerns Framework postulates that adherence is influenced by implicit judgements of personal need for the treatment (necessity beliefs) and concerns about the potential adverse consequences of taking it.

http://ogg.osu.edu/media/documents/health_lit/Necessity%20Concerns%20Framework.pdf

Understanding Patients’ Adherence-Related Beliefs about Medicines Prescribed for Long-Term Conditions: A Meta-Analytic Review of the Necessity-Concerns Framework

Purpose: The implementation of patient-centered care (PCC) has been hampered by the lack of a clear definition and method of measurement. The purpose of this review is to identify the fundamental characteristics of PCC to clarify its definition, propose a method for measurement of PCC, and recommend effective PCC practices.

Data sources: Review of literature related to PCC, adherence and communication from Cinahl, PubMed Academic Search Premier, and Cochrane Library databases.

Conclusions: Research has shown that patient-centered interactions promote adherence and lead to improved health outcomes. The fundamental characteristics of PCC were identified as (a) patient involvement in care and (b) the individualization of patient care. The use of a numeric rating scale to measure the presence of these characteristics allows quantification from the patient perspective. Effective PCC practices were related to communication, shared decision making, and patient education.

Implications for practice: PCC is a measure of the quality of health care. Understanding the characteristics of PCC facilitates its implementation and measurement. Promoting PCC activities will improve adherence and encourage patient responsibility for health status.

Patient-centered care and adherence: Definitions and applications to improve outcomes

Medication adherence: factors influencing compliance with prescribed medication plans.

Background:The medication management of patients following coronary artery bypass graft (CABG) surgery may include antiplatelet agents, β-blockers. angio-tensin-converting enzyme inhibitors, and statins. However, poor adherence is common, and patient attitudes and beliefs ptay a role in adherence.Objective:To evaluate the association between self-reported adherence and the beliefs patients have about cardiovascular medicines used after CABG.Methods:Adults were surveyed 6–24 months following CABG. The validated Beliefs about Medicines Questionnaire (BMQ) assessed attitudes concerning the Specific Necessity, Specific Concerns, General Harm, and General Overuse of medicines. The validated medication adherence scale assessed self-reported adherence. Analysis included univariate comparison (BMQ scales) and multivariate logistic regression (identification of adherence predictor variables).Results:Of 387 patients surveyed, 132 (34%) completed the questionnaire. Nonparticipants were more likely to be female and h...

Medication Adherence following Coronary Artery Bypass Graft Surgery: Assessment of Beliefs and Attitudes

Poor adherence to medical therapy may cause as much as dollar 100 billion in unnecessary healthcare expenses each year. Nonadherence is a complicated and dynamic problem that involves patient, medication, and prescriber factors. The Case Management Adherence Guidelines (CMAG-1) are an evidence-based algorithm that introduces concepts and strategies for assessing medical knowledge and readiness to change (motivational interviewing). Once the assessment has been made, the guidelines can be used regularly to help patients become and remain adherent to their medication regimens. CMAG-1 and its tools, based on up-to-date information about adherence and ways to promote behavioral change, are designed to identify motivational and knowledge deficiencies that may block adherence. As information accumulates from centers that use it, CMAG-1 will be modified accordingly, with the goal of creating structured interaction with patients that will increase their knowledge and motivation to take medication appropriately.

Jon J. Vlasnik

Papers

Medication adherence: factors influencing compliance with prescribed medication plans.

Medication Adherence following Coronary Artery Bypass Graft Surgery: Assessment of Beliefs and Attitudes

Enhancing adherence to long-term medical therapy: a new approach to assessing and treating patients.

Evidence-based assessment and intervention strategies to increase adherence to prescribed medication plans.

Using case management guidelines to enhance adherence to long-term therapy.