Blood pressure outcomes of medication adherence interventions: systematic review and meta-analysis

Abstract

This systematic review applied meta-analytic procedures to integrate primary research that examined blood pressure outcomes of medication adherence interventions. Random-effects model analysis calculated standardized mean difference effect sizes. Exploratory dichotomous and continuous moderator analyses using meta-analytic analogues of ANOVA and regression were performed. Codable data were extracted from 156 reports with 60,876 participants. The overall weighted mean difference systolic effect size was 0.235 across 161 treatment versus control comparisons. The diastolic effect size was 0.189 from 181 comparisons. Effect sizes were significantly heterogeneous. Common risks of bias included lack of allocation concealment, unmasked data collectors, and absent intention-to-treat analyses. Exploratory moderator analyses suggested that habit-based interventions may be most effective. The largest effect sizes were for interventions delivered by pharmacists. The modest magnitude effect sizes suggest future research should explore novel higher dose interventions that might address multiple levels of influence on adherence behavior.

Adherence to Antihypertensive Therapy

“…With respect to health outcomes, larger intervention doses (measured by minutes per session and number of sessions) are more effective at improving BP. 55 Moreover, face-to-face versus mediated delivery of adherence interventions (eg, via mail) is associated with a larger decrease in diastolic BP (DBP), but not with a larger decrease in SBP 55 . Taken together, these findings indicate that effective interventions to promote adherence and improve BP control are likely to require ongoing, sustained focus with repeated contacts and a combination of strategies that can be tailored to patients’ needs.…”

“…57 There is low strength evidence supporting case management as an effective strategy for promoting adherence and improving BP outcomes. 54 Finally, home BP telemonitoring 58 and habit-based interventions 55 have larger effects on health outcomes compared to other interventions, but evidence for larger effects on adherence is limited. 11,58 …”

“…54,55,64–67 In fact, a recent meta-analysis found that pharmacist-delivered interventions had the largest effect on BP outcomes, followed by those delivered by advanced practice nurses, and then physicians. 55 Although it is clear that interventions delivered by pharmacists improve BP outcomes, there is a great deal of unexplained heterogeneity in effects 67 and it is uncertain if the effect on BP outcomes is mediated by improved adherence or by some other mechanism, as effects on adherence reported across reviews and meta-analyses are inconsistent. 11,54,64,66 …”

“…There is little evidence that, compared to other interventions, informational interventions, particularly those relying on written materials, or social support interventions are more effective at promoting antihypertensive medication adherence or improving health outcomes. 11,55 Data supporting the efficacy of particular behavioral interventions are also limited. Interventions using adherence problem-solving, decisional balance activities, and medication administration calendars are not associated with larger improvements in adherence.…”

Treatment adherence and illness self-management: introduction to the special issue

“…Leventhal et al (2016) reviewed the development of the common sense model of self-regulation (CSM) framework over several decades, its application to acute and chronic health threats, and provide comments and recommendations for future research to maximize CSM's contribution to research aimed at improving the self-management of illness. Conn et al (2016) conducted a systematic review and meta-analysis on blood pressure outcomes of medication adherence interventions across 156 studies and over sixty thousand participants. Another meta-analysis was conducted by Finitsis et al (2016) analyzing the utility of the visual analogue scale (VAS) to capture antiretroviral adherence in patients with HIV/ AIDS.…”