Interventions for enhancing medication adherence
Editorial Group: Cochrane Consumers and Communication Group
Published Online: 23 APR 2008
Assessed as up-to-date: 30 JAN 2007
Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD000011. DOI: 10.1002/14651858.CD000011.pub3.
- Publication Status: Edited (no change to conclusions)
- Published Online: 23 APR 2008
People who are prescribed self-administered medications typically take less than half the prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits of prescribed medications, but also might increase their adverse effects.
To update a review summarizing the results of randomized controlled trials (RCTs) of interventions to help patients follow prescriptions for medications for medical problems, including mental disorders but not addictions.
We updated searches of The Cochrane Library, MEDLINE, CINAHL, EMBASE, International Pharmaceutical Abstracts (IPA), PsycINFO (all via OVID) and Sociological Abstracts (via CSA) in January 2007 with no language restriction. We also reviewed bibliographies in articles on patient adherence and articles in our personal collections, and contacted authors of relevant original and review articles.
Articles were selected if they reported an unconfounded RCT of an intervention to improve adherence with prescribed medications, measuring both medication adherence and treatment outcome, with at least 80% follow-up of each group studied and, for long-term treatments, at least six months follow-up for studies with positive initial findings.
Data collection and analysis
Study design features, interventions and controls, and results were extracted by one review author and confirmed by at least one other review author. We extracted adherence rates and their measures of variance for all methods of measuring adherence in each study, and all outcome rates and their measures of variance for each study group, as well as levels of statistical significance for differences between study groups, consulting authors and verifying or correcting analyses as needed. The studies differed widely according to medical condition, patient population, intervention, measures of adherence, and clinical outcomes. Therefore, we did not feel that quantitative analysis was scientifically justified; rather, we conducted a qualitative analysis.
For short-term treatments, four of ten interventions reported in nine RCTs showed an effect on both adherence and at least one clinical outcome, while one intervention reported in one RCT significantly improved patient adherence, but did not enhance the clinical outcome. For long-term treatments, 36 of 83 interventions reported in 70 RCTs were associated with improvements in adherence, but only 25 interventions led to improvement in at least one treatment outcome. Almost all of the interventions that were effective for long-term care were complex, including combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counseling, family therapy, psychological therapy, crisis intervention, manual telephone follow-up, and supportive care. Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes.
For short-term treatments several quite simple interventions increased adherence and improved patient outcomes, but the effects were inconsistent from study to study with less than half of studies showing benefits. Current methods of improving adherence for chronic health problems are mostly complex and not very effective, so that the full benefits of treatment cannot be realized. High priority should be given to fundamental and applied research concerning innovations to assist patients to follow medication prescriptions for long-term medical disorders.
Plain language summary
Interventions for enhancing adherence to prescribed medications
Many people do not take their medication as prescribed. Our review considered trials of ways to help people follow prescriptions. For short-term drug treatments, counseling, written information and personal phone calls helped. For long-term treatments, no simple intervention, and only some complex ones, led to improvements in health outcomes. They included combinations of more convenient care, information, counseling, reminders, self-monitoring, reinforcement, family therapy, psychological therapy, mailed communications, crisis intervention, manual telephone follow-up, and other forms of additional supervision or attention. Even with the most effective methods for long-term treatments, improvements in drug use or health were not large. Several studies showed that telling people about adverse effects of their medications did not affect their use of the medications.
更新並回顧有關提升病患服藥遵囑性的隨機對照研究(randomized controlled trials；RCTs)之研究結果，其中病患醫療問題的類別包括有精神疾患，但不包括成癮性問題。
我們利用電腦搜尋更新至2004年9月的資料，包括MEDLINE、EMBASE、CINAHL、The Cochrane Library、International Pharmaceutical Abstracts (IPA)、PsycINFO及SOCIOFILE等資料庫，並無語言的限制。我們同時也回顧了關於病患遵囑性文獻及私人藏書的相關參考書目，並且聯繫了這些原著與文獻回顧的作者們。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan) 統籌。