Interventions to Improve Medication Adherence in Ethnically Diverse Patients: A Narrative Systematic Review

Abstract

Introduction: Ethnically diverse patients often have lower medication adherence relative to Whites. Certain ethnic groups are also more susceptible to cardiovascular and related diseases. It is critical to develop culturally tailored interventions to improve medication adherence in these ethnically diverse patients. Thus, the aim of this systematic review was to identify what interventions have been developed and tested to improve medication adherence in ethnically diverse patients with cardiovascular-related diseases. Method: A systematic search of peer-reviewed literature (MEDLINE, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Cochrane Central Register of Controlled Trials) was conducted to identify relevant articles. The narrative synthesis was performed based on elements offered by Popay et al. The mixed methods appraisal tool was used to appraise the quality of the included studies. Results: A total of 11,294 records were retrieved, and 34 articles met the inclusion criteria for this systematic review. Synthesis of the literature revealed four overarching intervention strategies used to improve medication adherence: pharmacist-mediated, primarily nurse-led, community-based and community-health worker led, and text-message and phone-based. Discussion: Several approaches can be used to improve medication adherence in ethnically diverse patients, although details on the approaches and conditions to produce optimal improvements for particular ethnic groups need to be determined in future studies. How does this affect culturally congruent health care?

Medication management in M inority, A sian and B lack ethnic older people in the United Kingdom: A mixed‐studies systematic review

“…46 However, effective communication and education strategies might not be equally effective for everyone and everywhere. Previous studies, including a systematic review, 47 show how educational programmes improve adherence amongst minority groups provided that they are tailored to the cultural beliefs of the target population.…”

Medication Adherence Rate in Arab Patients With Cardiovascular Disease: A Systematic Review

“…Low medication adherence rates among Arab populations may be due to specific cultural and personal beliefs, such as the necessity of medication and attitudes toward taking daily medications, when compared with other ethnic groups. Beliefs about medications can be influenced by history, culture, family experiences, and individual preferences and may involve complexities that go beyond the risks and benefits typically discussed during the patient encounter (Singh et al, 2021). This is consistent with the findings of a previous study on Arab patients in the Middle East, which found that patients were more likely to have negative beliefs about medications (Al-Ganmi et al, 2020).…”

“…According to one study, medications are responsible for half of the overall reduction in CVD mortality over the last 20 years (Singh et al, 2021). At 2-year follow-up, medication adherent patients had a significantly lower rate (18.9%) of major adverse cardiovascular events compared with nonadherent patients (26.3%; Heterogeneity (HR) 0.73; p = .0004), as well as lower medical costs for hospitalization; US$371 versus US$907, (Ritchey et al, 2016).…”

Worldwide characteristics and trends of pharmacist interventions contributed to minimize health disparities

“…Despite the growing body of literature regarding pharmacy‐based interventions to reduce health disparities, cohesive information on such interventions worldwide is lacking. Prior published systematic reviews aimed at evaluating interventions to reduce health disparities were limited to targeting specific populations with specific outcomes, which provides an inadequate picture of overall implementation of interventions 21‐28 . In addition, prior studies reported non‐specific providers and evidence of pharmacist involvement is still uncertain 26‐29 .…”

“…Prior published systematic reviews aimed at evaluating interventions to reduce health disparities were limited to targeting specific populations with specific outcomes, which provides an inadequate picture of overall implementation of interventions. [21][22][23][24][25][26][27][28] In addition, prior studies reported non-specific providers and evidence of pharmacist involvement is still uncertain. [26][27][28][29] Furthermore, those reviews were limited to U.S.-based interventions and worldwide summaries are lacking.…”