Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis

Abstract

BACKGROUND: Randomized clinical trials (RCTs), mostly conducted among minority populations, have reported that motivational interviewing (MI) can improve medication adherence. OBJECTIVES: To evaluate the impact of MI and of the MI delivery format, fidelity assessment, fidelity-based feedback, counselors' background and MI exposure time on adherence. DATA SOURCES: We searched the MEDLINE database for studies published from 1966 until February 2015. STUDY ELIGIBILITY CRITERIA: We included RCTs that compared MI to a control group and reported a numerical measure of medication adherence. DATA SYNTHESIS: The main outcome was medication adherence defined as any subjective or objective measure reported as the proportion of subjects with adequate adherence or mean adherence and standard deviation. For categorical variables we calculated the relative risk (RR) of medication adherence, and for continuous variables we calculated the standardized mean difference (SMD) between the MI and control groups. RESULTS: We included 17 RCTs. Ten targeted adherence to HAART. For studies reporting a categorical measure (n = 11), the pooled RR for medication adherence was higher for MI compared with control (1.17; 95 % CI 1.05-1.31; p < 0.01). For studies reporting a continuous measure (n = 11), the pooled SMD for medication adherence was positive (0.70; 95 % CI 0.15-1.25; p < 0.01) for MI compared with control. The characteristics that were significantly (p < 0.05) associated with medication adherence were telephonic MI and fidelity-based feedback among studies reporting categorical measures, group MI and fidelity assessment among studies reporting continuous measures and delivery by nurses or research assistants. Effect sizes differed in magnitude, creating high heterogeneity. CONCLUSION: MI improves medication adherence at different exposure times and counselors' educational level. However, the evaluation of MI characteristics associated with success had inconsistent results. Larger studies targeting diverse populations with a variety of chronic conditions are needed to clarify the effect of different MI delivery modes, fidelity assessment and provision of fidelity based-feedback.KEY WORDS: adherence; behavioral medicine; patient engagement.

Randomized controlled trial of motivational interviewing for psychogenic nonepileptic seizures

“…Motivational interviewing has previously been used to enhance adherence with medical therapies and psychotherapy, resulting in improved patient outcomes, in patient populations with high rates of ambivalence and nonadherence . Similarly, our prior observational study of patients with PNES has shown that there is an association between adherence with psychotherapy and improved outcomes .…”

“…Motivational interviewing (MI) is a patient‐oriented counseling style that was developed to address the problem of ambivalence about behavioral change . MI has been shown to be effective in improving patient engagement and adherence with numerous medical treatments and psychotherapy in a number of medical and psychiatric conditions, although never in PNES or other functional neurological disorders …”

Favorable effects of motivational interviewing and support in a patient with schizophrenia and alcohol abuse

“…Previous reports have demonstrated the effectiveness of motivational interviewing for patients with a variety of conditions, such as attention deficit/hyperactivity disorder, obesity, medication adherence, human immunodeficiency virus, and alcohol misuse . First, it is crucial to understand the underlying spirit or mindset of motivational interviewing and to master the core skills, as shown in Figure , through by repeated simulation trainings and audio or video recordings with feedback learning.…”

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“…MI is associated with better adherence to medications (6), higher rates of successful smoking cessation (7), and increased physical activity (8). Given this evidence, we previously hypothesized that MI would promote and help maintain adherence to an exercise prescription.…”