Interventions to improve adherence to prescriptions tend to produce only modest benefits

Glazier, Associate Professor Richard H. MD, MPH

Inner City Health Research Unit, St Michael's Hospital and Department of Family and Community Medicine; University of Toronto; Canada

Abstracted from:McDonald H, Garg A, Haynes B. Interventions to enhance patients' adherence to medication prescriptions. JAMA 2002; 288: 2868-2879 .

Sources of funding: Population Health Information Project; Canadian Institutes of Health Research; Kidney Foundation of Canada.

Correspondence to: B Haynes, Department of Clinical Epidemiology and Biostatistics, McMaster University Medical Centre, Hamilton, Ontario, Canada. Email: [email protected]

Abstract provided by Bazian Ltd, London

Evidence-based Healthcare 7(2):p 88-91, June 2003.

BACKGROUND

Low patient adherence to prescription medications may reduce their benefit. Increasing adherence may not only improve patient outcomes, but also decrease the complexity, cost and duration of treatment.

OBJECTIVE

To assess randomised trials of interventions that purport to increase patient adherence to prescribed medications.

METHOD

Systematic review.

SEARCH STRATEGY

The authors searched MEDLINE, CINAHL, PsychLit, Sociofile, IPA, EMBASE, the Cochrane Library and reference lists of identified trials and reviews (1967 to August 2001). The authors of included studies were contacted for additional published or unpublished trials.

INCLUSION/EXCLUSION CRITERIA

Unconfounded randomised trials of interventions to increase adherence to prescribed medications were eligible if they focused on self-administered medication for medical or psychiatric disorders; reported adherence and treatment outcome; had minimum 80% follow-up of each group, and had follow-up of at least 6 months for trials with initially positive findings. There were no language restrictions. Thirty-three studies were included with 39 interventions. The studies comprised various venues, patient characteristics, selection methods, reporting, clinical disorders and adherence measures. Meta-analysis was not performed due to differences in interventions, treatments and outcomes.

OUTCOMES

Change in adherence to prescription medications.

MAIN RESULTS

Adherence to medication improved in 49% of interventions. Treatment outcomes improved in 17% of interventions. Improvements in adherence and outcomes were modest. The most effective interventions were complex. They included combinations of more convenient care, information, counselling, reminders, self monitoring, reinforcement and other supervision or additional attention.

AUTHORS' CONCLUSIONS

Interventions to increase adherence to prescriptions for chronic health problems tend to be complex and labour intensive. Most interventions are not associated with major improvements. More innovative approaches to increase adherence are needed.