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Meta-Analysis
. 2016 Mar-Apr;19(2):277-85.
doi: 10.1016/j.jval.2015.12.001. Epub 2016 Jan 14.

Patient-Centered Outcomes of Medication Adherence Interventions: Systematic Review and Meta-Analysis

Vicki S Conn  1 , Todd M Ruppar  2 , Maithe Enriquez  2 , Pamela S Cooper  2
Affiliations
Meta-Analysis

Patient-Centered Outcomes of Medication Adherence Interventions: Systematic Review and Meta-Analysis

Vicki S Conn et al. Value Health. 2016 Mar-Apr.

Abstract

Objective: Using meta-analytic procedures to synthesize changes in patient-centered outcomes after medication adherence interventions.

Methods: Strategies to locate studies included online searches of 13 databases and 19 research registries, hand searches of 57 journals, and author and ancestry searches of all eligible studies. Search terms included patient compliance, medication adherence, and related terms. Searches were conducted for all studies published since 1960. Eligible published or unpublished primary studies tested medication adherence interventions and reported medication knowledge, quality of life, physical function, and symptom outcomes. Primary study attributes and outcome data were reliably coded. Overall standardized mean differences (SMDs) were analyzed using random-effects models. Dichotomous and continuous moderator analyses and funnel plots were used to explore risks of bias.

Results: Thorough searching located 141 eligible reports. The reports included 176 eligible comparisons between treatment and control subjects across 23,318 subjects. Synthesis across all comparisons yielded statistically significant SMDs for medication knowledge (d = 0.449), quality of life (d = 0.127), physical function (d = 0.142), and symptoms (d = 0.182). The overall SMDs for studies focusing on subsamples of patients with specific illnesses were more modest but also statistically significant. Of specific symptoms analyzed (depression, anxiety, pain, energy/vitality, cardiovascular, and respiratory), only anxiety failed to show a significant improvement after medication adherence interventions. Most SMDs were significantly heterogeneous, and risk of bias analyses suggested links between study quality and SMDs.

Conclusions: Modest but significant improvements in patient-centered outcomes were observed after medication adherence interventions.

Keywords: anxiety; medication adherence; meta-analysis; patient knowledge; patient-centered outcomes; physical function; quality of life; symptoms.

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Figures

Figure 1
Figure 1
Identification and flow of potentially eligible studies through the systematic review
See this image and copyright information in PMC

References

Appendix: Primary Study Reports

    1. Abrahams N, Jewkes R, Lombard C, Mathews S, Campbell J, Meel B. Impact of telephonic psycho-social support on adherence to post-exposure prophylaxis (PEP) after rape. AIDS Care: Psychological and Socio-Medical Aspects of AIDS/HIV. 2010;22(10):1173–1181. - PubMed
    1. Adamolekun B, Mielke JK, Ball DE. An evaluation of the impact of health worker and patient education on the care and compliance of patients with epilepsy in Zimbabwe. Epilepsia. 1999;40(4):507–511. - PubMed
    1. Al Mazroui NR, Kamal MM, Ghabash NM, Yacout TA, Kole PL, McElnay JC. Influence of pharmaceutical care on health outcomes in patients with type 2 diabetes mellitus. Br J Clin Pharmacol. 2009;67(5):547–557. - PMC - PubMed
    1. Amado Guirado E, Pujol Ribera E, Pacheco Huergo V, Borras JM. Knowledge and adherence to antihypertensive therapy in primary care: Results of a randomized trial. Gac Sanit. 2011;25(1):62–67. - PubMed
    1. Anderson KO, Mendoza TR, Payne R, et al. Pain education for underserved minority cancer patients: A randomized controlled trial. J Clin Oncol. 2004;22:4918–4925. - PubMed

References

    1. National Council on Patient Information and Education . Enhancing prescription medicine adherence: a national action plan. National Council on Patient Information and Education; Rockville, MD: 2007.
    1. World Health Organization . Adherence to long-term therapies: evidence for action. World Health Organization; Geneva, Switzerland: 2003.
    1. Christiansen A. Patient Adherence to Medical Treatment Regimens. Yale University Press; New Haven, CT: 2004.
    1. McDonald HP, Garg AX, Haynes R. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA. 2002;288:2868–79. - PubMed
    1. Urquhart J. Pharmionics: research on what patients do with prescription drugs. Pharmacoepidemiol Drug Saf. 2004;13:587–90. - PubMed

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