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. 2015 Mar 11:9:435-48.
doi: 10.2147/PPA.S77053. eCollection 2015.

Impact of patient programs on adherence and persistence in inflammatory and immunologic diseases: a meta-analysis

Chakkarin Burudpakdee  1 , Zeba M Khan  2 , Smeet Gala  3 , Merena Nanavaty  3 , Satyin Kaura  2
Affiliations

Impact of patient programs on adherence and persistence in inflammatory and immunologic diseases: a meta-analysis

Chakkarin Burudpakdee et al. Patient Prefer Adherence. .

Abstract

Objectives: Patient adherence and persistence is important to improve outcomes in chronic conditions, including inflammatory and immunologic (I&I) diseases. Patient programs that aim at improving medication adherence or persistence play an essential role in optimizing care. This meta-analysis assessed the effectiveness of patient programs in the therapeutic area of I&I diseases.

Methods: A global systematic literature review was conducted with inclusion criteria of: patient programs in I&I diseases; published in English language between January 2008 and September 2013; and reporting measures of adherence or persistence, including medication possession ratio >80% and persistence rate. A meta-analysis was performed using a random effects model. Subgroup analyses based on the type of program was performed whenever feasible.

Results: Of 67 studies reviewed for eligibility, a total of 17 studies qualified for inclusion in the meta-analysis. Overall, patient programs increased adherence (odds ratio [OR]=2.48, 95% confidence interval [CI]=1.68-3.64, P<0.00001) as compared with standard of care. Combination patient programs that used both informational and behavioral strategies were superior in improving adherence (OR=3.68, 95% CI=2.20-6.16, P<0.00001) compared with programs that used only informational (OR=2.16, 95% CI=1.36-3.44, P=0.001) or only behavioral approaches (OR=1.85, 95% CI=1.00-3.45, P=0.05). Additionally, patients were more likely to be persistent (OR=2.26, 95% CI=1.16-4.39, P=0.02) in the intervention group as compared with the control group. Persistence (in days) was significantly (P=0.007) longer, by 42 additional days, in the intervention group than in the control group.

Conclusions: Patient programs can significantly improve adherence as well as persistence in the therapeutic area of I&I diseases. Programs employing a multimodal approach are more effective in improving adherence than programs with informational or behavioral strategies alone. This in turn may improve patient outcomes.

Keywords: behavioral; informational; patient interventions; systematic literature review.

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Figures

Figure 1
Figure 1
Flow diagram of systematic literature search. Abbreviation: I&I, inflammatory and immunologic.
Figure 2
Figure 2
Program effectiveness on adherence, by type of patient program. Notes: The study by Sewerynek et al is one study with three intervention groups: (1) the patient counseling group; (2) the biochemical information groups; and (3) the nurse-assistance group. The squares in the lines represent the effect estimate, the lines represent the length of the confidence interval, the diamonds represents the overall result of the meta-analysis. Abbreviations: CI, confidence interval; IV, inverse variance.
Figure 3
Figure 3
Program effectiveness measured as % persistence. Notes: The squares in the lines represent the effect estimate, the lines represent the length of the confidence interval, the diamonds represent the overall result of the meta-analysis. Abbreviations: CI, confidence interval; IV, inverse variance.
Figure 4
Figure 4
Effect of intervention vs control on persistence (in days) in I&I. Notes: The squares in the lines represent the effect estimate, the lines represent the length of the confidence interval, the diamonds represent the overall result of the meta-analysis. Abbreviations: CI, confidence interval; I&I, inflammatory and immunologic; SD, standard deviation; IV, inverse variance.
Figure 5
Figure 5
Risk of bias summary.
See this image and copyright information in PMC

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