Interventions for enhancing medication adherence.
Robby Nieuwlaat,Nancy L. Wilczynski,Tamara Navarro,Nicholas Hobson,Rebecca A. Jeffery,Arun Keepanasseril,Thomas Agoritsas,Niraj Mistry,Alfonso Iorio,Susan M. Jack,Bhairavi Sivaramalingam,Emma Iserman,Reem A. Mustafa,Dawn Jedraszewski,Chris Cotoi,R. Brian Haynes +15 more
TLDR
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.Abstract:
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.read more
Citations
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Journal ArticleDOI
2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).
Borja Ibanez,Stefan James,Stefan Agewall,Manuel J. Antunes,Chiara Bucciarelli-Ducci,Héctor Bueno,Alida L.P. Caforio,Filippo Crea,John A. Goudevenos,Sigrun Halvorsen,Gerhard Hindricks,Adnan Kastrati,Mattie J. Lenzen,Eva Prescott,Marco Roffi,Marco Valgimigli,Christoph Varenhorst,Pascal Vranckx,Petr Widimský +18 more
TL;DR: 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation are published.
Journal ArticleDOI
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Paul K. Whelton,Robert M. Carey,Wilbert S. Aronow,Donald E. Casey,Karen J. Collins,Cheryl Dennison Himmelfarb,Sondra M. DePalma,Samuel S. Gidding,Kenneth Jamerson,Daniel W. Jones,Eric J. MacLaughlin,Paul Muntner,Bruce Ovbiagele,Sidney C. Smith,Crystal C. Spencer,Randall S. Stafford,Sandra J. Taler,Randal J. Thomas,Kim A. Williams,Jeff D. Williamson,Jackson T. Wright +20 more
TL;DR: Since 1980, the American College of Cardiology and American Heart Association have translated scientific evidence into clinical practice guidelines (guidelines) with recommendations to improve cardiovascular health.
Journal ArticleDOI
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
Paul K. Whelton,Robert M. Carey,Wilbert S. Aronow,Donald E. Casey,Karen J. Collins,Cheryl Dennison Himmelfarb,Sondra M. DePalma,Samuel S. Gidding,Kenneth Jamerson,Daniel W. Jones,Eric J. MacLaughlin,Paul Muntner,Bruce Ovbiagele,Sidney C. Smith,Crystal C. Spencer,Randall S. Stafford,Sandra J. Taler,Randal J. Thomas,Kim A. Williams,Jeff D. Williamson,Jackson T. Wright +20 more
TL;DR: The next generation of scientists and decision-makers will have a greater understanding of what constitutes a credible threat to public health and how to protect them from that threat.
Journal ArticleDOI
2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes.
Juhani Knuuti,William Wijns,Antti Saraste,Davide Capodanno,Emanuele Barbato,Christian Funck-Brentano,Eva Prescott,Robert F. Storey,Christi Deaton,Thomas Cuisset,Stefan Agewall,Kenneth Dickstein,Thor Edvardsen,Javier Escaned,Bernard J. Gersh,Pavel Svitil,Martine Gilard,David Hasdai,Robert Hatala,Felix Mahfoud,Josep Masip,Claudio Muneretto,Marco Valgimigli,Stephan Achenbach,Jeroen J. Bax +24 more
TL;DR: In this article, the authors present guidelines for the management of patients with coronary artery disease (CAD), which is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries.
Journal ArticleDOI
European Position Paper on Rhinosinusitis and Nasal Polyps 2020
Wytske Fokkens,Valerie J. Lund,Joachim Mullol,Claus Bachert,Isam Alobid,Fuad M. Baroody,Noam A. Cohen,Anders Cervin,Richard Douglas,Philippe Gevaert,Christos Georgalas,Herman Goossens,Richard J. Harvey,Peter Hellings,Claire Hopkins,Nick Jones,Guy Joos,Livije Kalogjera,Bob Kern,Marek L. Kowalski,David Price,Herbert Riechelmann,Rodney J. Schlosser,Brent A. Senior,Mike Thomas,Elina Toskala,Richard Louis Voegels,De Yun Wang,Peter-John Wormald +28 more
TL;DR: The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012 and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery.
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