Medication adherence outcomes of 771 intervention trials: Systematic review and meta-analysis

Abstract

Excellent medication adherence contributes to decreases in morbidity, mortality, and health care costs. Although researchers have tested many interventions to increase adherence, results are sometimes conflicting and often unclear. This systematic review applied meta-analytic procedures to integrate primary research that tested medication adherence interventions. Comprehensive searching completed in 2015 located 771 published and unpublished intervention studies with adherence behavior outcomes. Random-effects model analysis calculated standardized mean difference effect sizes. Meta-analytic moderator analyses examined the association between adherence effect sizes and sample, design, and intervention characteristics. Analyses were conducted in 2016. A standardized mean difference effect size of 0.290 comparing treatment and control groups was calculated. Moderator analyses revealed larger effect sizes for habit-based and behavioral-targeted (vs. cognitive-focused) interventions. The most effective interventions were delivered face-to-face, by pharmacists, and administered directly to patients. Effect sizes were smaller in studies with older and homeless participants. Risks of bias were common; effect sizes were significantly lower among studies with masked data collectors and intention-to-treat analyses. The largest effect sizes were reported by studies using medication electronic event monitoring and pill count medication adherence measures. Publication bias was present. This most comprehensive review to date documented that, although interventions can increase adherence, much room remains for improvement. Findings suggest health care providers should focus intervention content on behavioral strategies, especially habit-based interventions, more so than cognitive strategies designed to change knowledge and beliefs.

Adherence to medication in adults with Cystic Fibrosis: An investigation using objective adherence data and the Theoretical Domains Framework

“…The highest adherers commonly reported that they did their treatments automatically, indicating that it was habitual. This is consistent with recent research showing the importance of automatic motivation habits in adherence (Hoo et al ., ; Phillips, Cohen, Burns, Abrams, & Renninger, ), including evidence that adherence interventions that focus on habit formation are the most effective (Conn & Ruppar, ). Habits mean that adherence requires less cognitive effort (Gardner, de Bruijn, & Lally, ), and this means that habits can be maintained in circumstances that might make treatment taking more challenging (Gardner, ).…”

Bibliometric analysis of global publications in medication adherence (1900–2017)

“…The keywords used in the search strategy were obtained from several previous systematic reviews in the field of medication adherence . The search strategy was based on two queries that were combined together to perform the search.…”

“…The keywords used in the search strategy were obtained from several previous systematic reviews in the field of medication adherence. [21][22][23][24] The search strategy was based on two queries that were combined together to perform the search. The first search query was based on the title search using phrases such as 'medication adherence' or 'adherence to medication'.…”

Treatment perceptions in patients with asthma: Synthesis of factors influencing adherence

“…This is key for identifying reasons why patients do not adhere to their recommended treatment as addressing perceptual barriers, through behavioural-targeted interventions, have been shown to be more effective for improving adherence than addressing non-perceptual barriers [35]. A recent review of determinants of inhaler adherence in adults based on observational data linked adherence to a strong perceived need for medication (necessity beliefs); no other determinants were found to be predictive [36].…”