Medicines are the cornerstone of treatment for many health problems. There are many strategies to help people use them safely and effectively, but research in the area is not well organised across populations, diseases and settings. This makes it difficult for people in government, as well as health professionals and consumers, to know which strategies work and which don’t.
In the past, much research has focussed on the concerns of health professionals and researchers, often with a preoccupation on whether people take their medicines as directed. This is commonly called medicines adherence. More recently, ideas about the patient-doctor partnership, recognition of the role of family in managing medicines and understanding that managing your medicines is more than simply taking them have led researchers – including our team – to explore the full range of ways in which people use medicines.
Our Cochrane overview is a new tier in research (1). It's a systematic overview of evidence from systematic reviews. In our case, we used reviews of controlled studies of interventions. From thousands of systematic reviews, we looked for, selected, summarised and synthesized 37 separate systematic reviews, which collectively draw on the findings from hundreds of pieces of research.
Our first step in selecting the reviews was that we agreed to look at a very wide range of interventions or strategies to help people to take and manage their medicines. This included things such as ways to provide information or education, to help people acquire skills, to support behaviour change, and to improve the quality of medicines use. We also wanted to concentrate on interventions which focussed on, or were directed to, consumers (for example, education directed to consumers rather than to doctors). By consumers, we mean people who are patients, members of families such as those in a caring role, and members of the public with an interest in health.
Having found the 37 systematic reviews, what did they tell us? This first thing to say is that no single intervention achieved all the health outcomes we would like, or were effective for all people or conditions, but this might not be an achievable goal anyway. Instead, we found that some interventions hold promise for achieving outcomes such as improving knowledge, adherence, clinical health outcomes and use of services. These include self-monitoring and self management, simplified dosing and interventions directly involving pharmacists. Other interventions seemed to improve adherence to medicines but not all the time. These include reminders, education combined with self-management skills training, counselling or support, financial incentives and lay health workers.
Assembling the evidence across so many reviews also sheds light on ineffective strategies. For example, interventions that provide information alone are not effective for changing health or medicine-taking outcomes.
Unfortunately, the evidence is very sparse for some populations, including children and young people, people with more than one health problem, and family carers who often manage medicines. Doing the overview helps to highlight these gaps and to identify possible priorities for new research.
Our overview can be used in several ways because it provides different groups of people with different kinds of information. Health professionals who want to implement a new way to improve people's use of medicines can use it to inform their choice of strategy, consider the different options available to them and the types of outcomes that have been achieved. Researchers and those who commission or fund research can use it to determine where research is needed or should be a priority.
This Cochrane overview is important because most health systems are pursuing high quality and safe health care with increasingly limited resources, and medicines are a major cost for many individuals and for governments. The research we have compiled shows that there are many preventable problems, such as adverse events which could be avoided through better communication, or poor adherence due to a variety of reasons. By bringing all the relevant systematic reviews together in one place, our aim is to improve decision making in health systems, which in turn will improve health.