Barriers and Facilitators to Implementing Evidence for Improving Medication Adherence in Elderly Patients with Hypertension: a scoping review

Abstract

Background With the seriousness of global aging, hypertension has become a major health hazard for the elderly. Improving medication adherence is one of the measures to effectively control blood pressure, and although there has been a great number of publications on how to improve medication adherence in elderly hypertensive patients, implementation in real practice remains a challenge. Moreover, little attention has been paid to what exactly are the factors that influence the implementation of the evidence. The purpose of this review is to provide a systematic overview of the barriers and facilitators that influence the implementation of evidence for improving medication adherence in the elderly hypertensive patient. Methods This review is based on Arksey and O'Malley methodology and searched six electronic databases. Two independent reviewers were involved in the screening and graphing of the data. Findings were synthesized and categorized using the five domains of the Consolidated Framework for Implementation Research (CFIR). Results A total of 15 studies were included in the final review. Barriers and facilitators were mapped to constructs in 14 of the five domains of the CFIR. The most frequently cited barriers were mapped to constructs within the "intervention characteristics" domain. Similarly, the most frequently mentioned facilitators were derived from the "intervention characteristics". Overall, the intervention content of the existing studies was not generalizable and accessible, whereas other factors such as family involvement in the “process” were effective in facilitating the implementation of the evidence. Conclusions This review identifies barriers and facilitators in the implementation of evidence about improving medication adherence in the elderly hypertensive patient. Future research should focus more on how to intervene with barriers and facilitators so that they can actually be implemented to promote improved medication adherence in the elderly hypertensive population.