Interventions for helping patients to follow prescriptions for medications
Abstract
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 and efficiency of health care, but also might increase its adverse effects.
Objectives
To update a review summarising the results of randomised controlled trials (RCTs) of interventions to help patients follow prescriptions for medications for medical problems, focusing on trials that measured both adherence and clinical outcomes.
Search methods
Computerised searches to August 2001 in MEDLINE, CINAHL, The Cochrane Library, International Pharmaceutical Abstracts (IPA) PsychInfo, and Sociofile; bibliographies in articles on patient adherence; articles in the reviewers' personal collections; and contact with authors of original and review articles on the topic.
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
Information on study design features, interventions and controls, and results were extracted by one reviewer and confirmed by at least one other reviewer. The studies were too disparate to warrant meta‐analysis.
Main results
For short‐term treatments, one of three interventions reported in three RCTs showed an effect on both adherence and clinical outcome. Eighteen of 36 interventions for long‐term treatments reported in 30 RCTs were associated with improvements in adherence, but only 16 interventions led to improvements in treatment outcomes. 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, counselling, family therapy, and other forms of additional supervision or attention by a health care provider (physician, nurse, pharmacist or other). Even the most effective interventions did not lead to large improvements in adherence and treatment outcomes. Two studies showed that telling patients about adverse effects of treatment did not affect their adherence.
Authors' conclusions
The full benefits of medications cannot be realised at currently achievable levels of adherence. Current methods of improving adherence for chronic health problems are mostly complex and not very effective. Innovations to assist patients to follow medication prescriptions are needed.
PICOs
Plain language summary
Combinations of interventions such as more convenient care, reminders, reinforcement, and self‐monitoring, can help people to follow prescriptions for medications
Many people do not take their medication as prescribed. The review considered trials of ways to help people follow prescriptions. For
short‐term drug treatments, counselling and written information helped. For longterm treatments, only some interventions led to improvements in health outcomes. They included combinations of more convenient care, information, counselling, reminders, self‐monitoring, reinforcement, family therapy, and other forms of additional supervision or attention. Even with the most effective methods, improvements in drug use or health were not large. There is some evidence that telling people about adverse effects of drugs does not
affect their use of the medications.
