CP-074 Interventions to improve medicines adherence in patients with several chronic conditions: an overview of systematic reviews

Abstract

BackgroundNon-adherence in patients with multiple chronic conditions (PMCC) is associated with poor disease control, reduced quality of life and increased risk of morbidity and mortalityPurposeTo assess the available scientific evidence regarding the efficacy of interventions aimed to improve medicines adherence that are applicable to PMCC.Material and methodsOverview of systematic reviews (SRs). The following databases were consulted (September 2013): PubMed, EMBASE, the Cochrane Library, CRD and WoS to identify SRs of clinical trials focused on PMCC, or otherwise, patients with chronic diseases common in the PMCC, or polypharmacy. SRs that compared the efficacy of any intervention aiming to improve compliance with medicines with clinical practice or other interventions were included. For every SR and type of intervention (behavioural, educational and combined) the percentage of clinical trials in which adherence improved was estimated. Rates were combined between SRs by means and ranges. Meta-analysis could not be conducted because of the heterogeneity of the data. This analysis was also applied to the components from those interventions described in ≥1 SR.Results566 articles were retrieved of which 9 SRs were included. None was specifically focused on PMCC but considered patients with chronic diseases common in PMCC, patients with more than one chronic disease and polypharmacy.Seven, three and six SRs reported behavioural, educational and combined interventions, respectively. The mean efficacy rates were 49% [0–100], 51% [0–100%] and 53% [44–75]. The components from those interventions which reported higher efficacy were: counselling about the patients’ target disease, the importance of treatment and compliance with treatment (5 SR, 79% [47–100]), reminders (4 SR, 70% [50–100]), simplified dosing (3 SR, 90% [75–100]) and special pill packaging (2 SR, 83% [66–100]).ConclusionThere is a large heterogeneity in the efficacy of interventions aimed to improve medicines adherence that are applicable to PMCC. Nevertheless, they seem to have a modest impact on adherence. Some components of the interventions appear to have greater efficacy.References and/or AcknowledgementsArch Intern Med 2007;167:540–50No conflict of interest.

Medication-related factors associated with health-related quality of life in patients older than 65 years with polypharmacy

“…Others have also observed a relationship between a higher number of medicines and a worse quality of life [ 16 , 17 ]. Moreover, this association has been reported concomitantly with errors in taking medication and lack of adherence [ 10 , 46 ]. The associations among these factors make it important to consider that patients’ problems are not always solved with new medicines.…”

“…Among such measures, those found to be most effective are interventions to provide better advice to patient about their main illness, improve the relevance of treatment and adherence, and simplify dosages and scheduling in order to reduce the complexity of pharmacotherapy. Other potentially effective measures include personalized dosage systems, strategies to enhance face-to-face or phone communication between the health professional and the patient, and the use of devices to send patients reminders about their medications and doses [ 46 , 49 , 50 ].…”