Intervention Review

Interventions for enhancing medication adherence

  1. R. Brian Haynes1,*,
  2. Elizabeth Ackloo2,
  3. Navdeep Sahota3,
  4. Heather Pauline McDonald4,
  5. Xiaomei Yao5

Editorial Group: Cochrane Consumers and Communication Group

Published Online: 23 APR 2008

Assessed as up-to-date: 30 JAN 2007

DOI: 10.1002/14651858.CD000011.pub3


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.

Author Information

  1. 1

    McMaster University, Departments of Clinical Epidemiology & Biostatistics, and Medicine, Hamilton, Ontario, Canada

  2. 2

    McMaster University , Health Research Methodology Program, Hamilton, Ontario, Canada

  3. 3

    McMaster University, Bachelor of Health Sciences Program, Hamilton, ON, Canada

  4. 4

    McMaster University, Health Research Methodology Program, Hamilton, Ontario, Canada

  5. 5

    McMaster University, Department of Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada

*R. Brian Haynes, Departments of Clinical Epidemiology & Biostatistics, and Medicine, McMaster University, Faculty of Health Sciences, 1200 Main Street West, Room 3v43c, Hamilton, Ontario, L8N 3Z5, Canada. bhaynes@mcmaster.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 APR 2008

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

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.

Objectives

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.

Search methods

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.

Selection criteria

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.

Main results

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.

Authors' conclusions

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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

提高服藥遵囑性方法之研究

病患對於所開立的藥物通常只服用不到處方劑量的一半。協助病患按照醫囑服藥能提升藥物的療效,但同時也可能增加藥物的副作用。

目標

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。

搜尋策略

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。

選擇標準

我們選取文獻的條件必須是有關提升服藥遵囑性的無干擾隨機對照研究(RCT)。評估的變項要包括治療的服藥遵囑性與藥物療效,且兩組都有至少80%的追蹤完成率。如果是長期治療,則至少追蹤6個月的時間且在初期都有正面的療效。

資料收集與分析

由1 位作者負責摘錄有關研究設計介入組與對照組以及研究結果等資訊,另外至少有1位以上作者進行確認。我們所摘錄的資訊包括遵囑率及在測量遵囑性的方法之測量變異評估、所有和療效有關的比率、兩組間差異的測量、以及統計上呈顯著差異的判斷標準,並在必要時必要時照會作者以確認或更正分析結果。

主要結論

就短期的治療而言,在8個隨機對照研究中所報告的9種介入中,有4種可以有效提高遵囑性且改善至少1項的臨床預後,然而某個RCT卻報告了其介入雖然可大幅提高了病人的遵囑性,但無法改善其臨床預後。就長期治療而言,在49個RCT所提到的58種介入方式中,有26種和提高遵囑性有關,但其中卻只有18種介入方式可以改善至少1項的臨床預後。幾乎每個可以有效提高長期治療遵囑性的方式都很複雜,包括整合了更為便捷的照護、資訊、服藥提醒、自我監控、心理增強、諮詢、家族治療、心理治療、危機處理、互動式電話追蹤以及支持性照護等,即便是其中最有效的方法也無法大幅提高遵囑性和改善治療成果。有6項研究顯示,假設告知病人治療將產生的副作用,並不會因而影響 其遵囑性。

作者結論

林林種種的簡單方法用在提高短期遵囑性上是相對成功的。目前用於改善慢性疾病服藥遵囑性的方法大多複雜且成效不佳,也造成藥物的完整療效無法清楚了解,我們建議應優先把重心放在如何協助慢性病人提高其藥物遵囑性的基礎和應用研究上。

翻譯人

本摘要由成功大學附設醫院邱曉萱翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan) 統籌。

總結

許多患者並未按照處方服藥。我們分析了跟協助病人按照醫囑服藥有關的臨床試驗,發現對短期藥物治療而言,諮詢、書面資訊以及個人電話追蹤對改善遵囑性是有幫助的。對長期治療而言則沒有所謂的簡單方法,只有部份複雜的方法可用於協助改善臨床預後,包括結合更為便利的照護、資訊、諮詢、服藥提醒、自我監控、心理增強、家族治療、心理治療、危機處理、互動式電話追蹤,以及其他額外的監督或關注。即使是對長期治療而言最為有效的方式,對患者藥物服用或健康狀況的改善幅度仍然有限,還好幸運的是,有一些研究顯示即使告知病人藥物可能發生的副作用,並 不會因此影響到他們對藥物的使用。