A framework for planning and critiquing medication compliance and persistence research using prospective study designs

Gwadry-Sridhar, Femida; Manias, Elizabeth; Zhang, Ying; Roy, Anuja; Yu‐Isenberg, Kristina; Hughes, Dyfrig; Nichol, Michael B.

doi:10.1016/j.clinthera.2009.02.021

Cited by 33 publications

(28 citation statements)

References 53 publications

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“…Table 4 summarises nine main barriers and several recommendations for improvement, formulated considering the existing methodological advice for observational research [26] and adherence research [93] in order to invite further dialogue on this topic. The first barrier identified was the substantial study heterogeneity, not only in sample characteristics but also in variable selection, definition, measurement, study design and statistical analyses.…”

Section: Discussionmentioning

confidence: 99%

Asthma inhaler adherence determinants in adults: systematic review of observational data

et al. 2014

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Nonadherence to inhaled medication leads to poor asthma control and increased healthcare utilisation. Many studies exploring adherence determinants have been conducted, but summaries of the evidence are scarce. We performed a systematic review of observational research on determinants of asthma inhaler adherence among adults.We searched for articles in English reporting quantitative observational studies on inhaler adherence correlates among adults in developed countries, published in EMBASE, Medline, PsychInfo and PsychArticles in 1990-2014. Two coders independently assessed eligibility and extracted data, and assessed study quality. Results were summarised qualitatively into social and economic, and healthcare-, therapy-, condition-and patient-related factors.The 51 studies included mainly examined patient-related factors and found consistent links between adherence and stronger inhaler-necessity beliefs, and possibly older age. There was limited evidence on the relevance of other determinants, partly due to study heterogeneity regarding the types of determinants examined. Methodological quality varied considerably and studies performed generally poorly on their definitions of variables and measures, risk of bias, sample size and data analysis.A broader adoption of common methodological standards and health behaviour theories is needed before cumulative science on the determinants of adherence to asthma inhalers among adults can develop further. @ERSpublications Major opportunities for strengthening evidence on determinants of nonadherence to asthma inhalers: methods and theory

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Section: Discussionmentioning

confidence: 99%

Asthma inhaler adherence determinants in adults: systematic review of observational data

et al. 2014

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“…The limitations of this research support the need for future studies to adhere to guidelines concerning the design, conduct, analysis, and reporting of studies designed to assess the effects of adherence-enhancing interventions [67, 68]. …”

Section: Discussionmentioning

confidence: 99%

Identification and Assessment of Adherence-Enhancing Interventions in Studies Assessing Medication Adherence Through Electronically Compiled Drug Dosing Histories: A Systematic Literature Review and Meta-Analysis

Demonceau¹,

Ruppar

Kristanto³

et al. 2013

Drugs

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262

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BackgroundNon-adherence to medications is prevalent across all medical conditions that include ambulatory pharmacotherapy and is thus a major barrier to achieving the benefits of otherwise effective medicines.ObjectiveThe objective of this systematic review was to identify and to compare the efficacy of strategies and components thereof that improve implementation of the prescribed drug dosing regimen and maintain long-term persistence, based on quantitative evaluation of effect sizes across the aggregated trials.Data sourcesMEDLINE, EMBASE, CINAHL, the Cochrane Library, and PsycINFO were systematically searched for randomized controlled trials that tested the efficacy of adherence-enhancing strategies with self-administered medications. The searches were limited to papers in the English language and were included from database inception to 31 December 2011.Study selectionOur review included randomized controlled trials in which adherence was assessed by electronically compiled drug dosing histories. Five thousand four hundred studies were screened. Eligibility assessment was performed independently by two reviewers. A structured data collection sheet was developed to extract data from each study.Study appraisal and synthesis methodsThe adherence-enhancing components were classified in eight categories. Quality of the papers was assessed using the criteria of the Cochrane Handbook for Systematic Reviews of Interventions guidelines to assess potential bias. A combined adherence outcome was derived from the different adherence variables available in the studies by extracting from each paper the available adherence summary variables in a pre-defined order (correct dosing, taking adherence, timing adherence, percentage of adherent patients). To study the association between the adherence-enhancing components and their effect on adherence, a linear meta-regression model, based on mean adherence point estimates, and a meta-analysis were conducted.ResultsSeventy-nine clinical trials published between 1995 and December 2011 were included in the review. Patients randomized to an intervention group had an average combined adherence outcome of 74.3 %, which was 14.1 % higher than in patients randomized to the control group (60.2 %). The linear meta-regression analysis with stepwise variable selection estimated an 8.8 % increase in adherence when the intervention included feedback to the patients of their recent dosing history (EM-feedback) (p < 0.01) and a 5.0 % increase in adherence when the intervention included a cognitive-educational component (p = 0.02). In addition, the effect of interventions on adherence decreased by 1.1 % each month. Sensitivity analysis by selecting only high-quality papers confirmed the robustness of the model. The random effects model in the meta-analysis, conducted on 48 studies, confirmed the above findings and showed that the improvement in adherence was 19.8 % (95 % CI 10.7–28.9 %) among patients receiving EM-feedback, almost double the improvement in adherence for studies that did not inclu...

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“…This weakness is also observed among Iranian publications. However, international initiatives have focused on standardizing concepts of AM research [1,46,47] and future studies are encouraged to comply with these research guidelines. There are different methods of measuring AM including pill count, pharmacological and biochemical markers, medical and dispensing records, self-report, and Medication Event Monitoring System (MEMS) [2].…”

Section: Discussionmentioning

confidence: 99%

A comprehensive review of adherence to diabetes and cardiovascular medications in Iran; implications for practice and research

Sarayani

Jahangard‐Rafsanjani

Hadjibabaie

et al. 2013

J Diabetes Metab Disord

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Treatment of diseases such as diabetes mellitus and cardiovascular disorders are highly dependent on medications and particularly adherence to medications to achieve optimal pharmacotherapy outcomes. Several factors can affect a patient’s adherence including: knowledge and beliefs about their illness and medications, concomitant psychological disorders, type of therapeutic regimen, and lack of access to medicines. In Iran, a middle income country, essential medicines are highly available and affordable. However, adherence to medications has not been emphasized especially for patients with diabetes and cardiovascular diseases. In the present study, we reviewed the available literature on adherence to medications used to treat diabetes and cardiovascular disorders in Iran. We systematically searched Scopus, Web of Science, PubMed, CINAHL, Google Scholar, Scientific Information Database, and IranMedex using a highly sensitive protocol on July 2012. We retrieved 1003 citations; and two independent researchers screened them for relevant publications. Studies were included if they reported rate or determinants of adherence to diabetes mellitus and cardiovascular medications. Trials on improving interventions were also included. The quality of studies was assessed using appropriate guidelines. Fourteen studies were eligible for data extraction and review. The definition of adherence and the measurement tools used were unclear among studies. Methodological caveats including inappropriate sample size, sampling methods, inclusion/exclusion criteria, and high rate of loss to follow-up were also observed. Nevertheless, adherence rate was reported to be 62.8-86.3% for oral hypoglycemic medications and 38.8-60.0% for cardiovascular medicines. Forgetfulness, lack of knowledge about medical condition and prescribed medications, and concerns about medications efficacy and side effects were consistently reported as barriers to adherence. Patient education plus telephone or short message service follow-ups were reported to improve adherence to oral hypo-glycemic medications. We did not find any high quality trials on adherence to cardiovascular medicines. In conclusion, adherence to cardiovascular and diabetes medications is not assured in Iranian patients. Based on the available literature, patient education and reinforcement interventions are required to address this issue. Future studies should employ careful designs and standard tools for assessment of adherence to medications.

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A framework for planning and critiquing medication compliance and persistence research using prospective study designs

Cited by 33 publications

References 53 publications

Asthma inhaler adherence determinants in adults: systematic review of observational data

Asthma inhaler adherence determinants in adults: systematic review of observational data

Identification and Assessment of Adherence-Enhancing Interventions in Studies Assessing Medication Adherence Through Electronically Compiled Drug Dosing Histories: A Systematic Literature Review and Meta-Analysis

A comprehensive review of adherence to diabetes and cardiovascular medications in Iran; implications for practice and research

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