Patients randomized to an intervention group had an average combined adherence outcome of 74. Metaanalysis of interventions to improve medication adherence. Adherence is a factor in the outcome of medical treatment, but the strength and moderators of the adherenceoutcome association have not been systematically assessed. Nonadherence is a crucial point for the success and safety of many therapies 3,4,5. A positive effect size indicates better adherence outcomes for treatment than for. Analysis of medication adherence interventions among. A large body of empirical data exists on the prediction of patient adherence from subjective and objective assessments of health status and disease severity. Background adherence is a factor in the outcome of medical treatment, but the strength and moderators of the adherenceoutcome association have not. Inadequate medication adherence limits effective treatment for. Extensive literature searching strategies were used to locate trials testing interventions with medication adherence behavior outcomes measured by electronic event monitoring, pharmacy refills, pill counts, and selfreports. Randomeffects models were used to estimate overall mean effect sizes ess for ma, knowledge, health outcomes, and health services. Results indicated a relationship between adherence and health outcomes, in that lower levels of adherence are related to negative health outcomes overall effect size d. It covers several areas that can have detrimental effects on patient health, including lifestyle, dietnutrition, exercise, and medication or supplement use. Objectivealthough poor medication adherence may contribute to inadequate diabetes control, ways to feasibly measure adherence in routine clinical practice have yet to be established.
Treatment adjustment and medication adherence for complex. Compliance to treatment is a key link between process and outcome in medical care. Metaanalysis of medical regimen adherence outcomes in. This paper reports the adherence outcome results of a metaanalysis. Metaanalyses of theory use in medication adherence. She calculated adherence rates in a metaanalysis of 569 studies and found an average nonadherence rate of 24. Medication nonadherence is a widespread problem that causes high costs worldwide.
Innovations in theory and practice are badly needed. Effectiveness and content analysis of interventions to. Adherence is a factor in the outcome of medical treatment, but the strength and moderators of the adherence outcome association have not been systematically assessed. Metaanalysis of interventions for medication adherence to antihypertensives. Understanding patients adherencerelated beliefs about. Effectiveness and content analysis of interventions to enhance medication adherence and blood pressure control in hypertension. The effects of patient support on treatment adherence and. The world health organization cites the 5 main issues with medication adherence as problems with the patient, medical condition, therapy, socioeconomics, and health system. Review methods predefined criteria were used to select studies reporting mortality among participants with good and poor adherence to drug. Healthcare provider targeted interventions to improve.
Medication adherence improve patient outcomes and reduce costs. Medication adherence can be defined as the extent to which a patients behaviour corresponds with the prescribed medication dosing regime, including time, dosing and interval of medication intake 1, 2. Interventions to promote adherence to antiretroviral therapy in africa. A meta analysis of studies of interventions to improve medication adherence revealed an increase in adherence of 4 to 11%. Many studies have shown that some degree of nonadherence occurs universally, in rich and poor countries alike, and is even seen in lifethreatening diseases 1,2 large variations have been reported in the extent of nonadherence in individual patients and populations. Purpose medication nonadherence, inconsistent patient selfmonitoring, and inadequate treatment adjustment exacerbate poor disease control. Medication adherence interventions for heart failure. Interventions to improve medication adherence in schizophrenia. Many interventions to improve patient adherence are unsuccessful and sound theoretical foundations are lacking. Quality of life and treatment adherence in hypertensive. Download citation patient adherence and medical treatment outcomes. Interventional tools to improve medication adherence. Russellinterventions to improve medication adherence among older adults. Due to the heterogeneity of outcomes across conditions, it was not feasible to conduct a metaanalysis as part of the research.
Medication adherence health care quality ama steps. It remains for audience members to determine whether the speakers interests or relationships may influence the presentation. Rationally prescribed medications are a principle intervention in primary care and a major element when considering the economics of health care. Interventions for improving patients adherence to medical treatment adherence to medical treatment plays a key role in maintaining or improving clinical outcomes. A number of potential determinants of medication nonadherence have been described so far. Associating medication adherence with improved outcomes.
Blood pressure outcomes of medication adherence interventions. Meta analysis of trials of interventions to improve medication adherence. In summary, subjective and objective measures have both advantages and disadvantages and should be used in combination. In general, medication adherence of participants in clinical trials is better than in clinical practice. However, the heterogenic quality of existing publications poses the need for the use of a rigorous methodology in building a list of such determinants. Improving prescription medicine adherence is key to better health care taking medicines as prescribed can lower costs and improve health outcomes successful treatment of disease with prescription medicines requires consistent use of the medicines as prescribed. Yet research shows that medicines commonly are not used as directed. Patient adherence and medical treatment outcomes a metaanalysis m. Numerous empirical studies from various populations and settings link patient treatment adherence to physicianpatient communication.
This study investigated the effectiveness of interventions to improve medication adherence ma in older adults. Healthcare provider targeted interventions to improve medication adherence. Sixtythree studies assessing patient adherence and outcomes of medical treatment were found involving medical regimens recommended by a nonpsychiatrist physician, and measuring patient adherence. Apr 25, 2020 meta analysis of studies of interventions to improve medication adherence revealed an increase in adherence of 411%.
Medication adherence is often a key clinical goal in assertive community treatment within a broadbased and vigorous program to deliver relevant psychiatric and rehabilitative services. Publications were screened according to predefined. Poor compliance may reduce the power of a study and lead to an underestimation of the efficacy of a treatment and dismissal of a potentially useful therapeutic agent. Based on the interventions included in this metaanalysis, there is no single intervention that improves adherence to. Social support and patient adherence to medical treatment. Outcomes included allcause medical costs, acute care resource utilization, and acute complications. Physician communication and patient adherence to treatment a metaanalysis kelly b. Using a randomeffects model, the estimate of the overall effect size was small d.
She calculated adherence rates in a metaanalysis of 569 studies and found an average non adherence rate of 24. Metaanalysis of trials of interventions to improve. For most medical conditions, correct diagnosis and effective medical treatment are essential to a patients survival and quality of life. Randomeffects model analysis calculated standardized mean difference effect sizes. Publications were screened according to predefined inclusion. As this study is focusing specifically on hypertension, it is anticipated that most of the included interventions will have a common outcome of change in blood pressure in. Studies with sample size greater than 10 were included only if they precisely behaviorally defined the construct of adherence e. Therapist adherencecompetence and treatment outcome.
Christensenpatient adherence to medical treatment regimens. Areas of adherence most commonly, adherence is thought of as it relates to taking medication. Adherence is behaviour, although it is often confused with its outcome. Studies quantifying the cost of medication nonadherence in relation to economic impact were included. Medication adherence influencing factorsan updated.
For example, a metaanalysis of studies examining social support and patient adherence to medication showed that art adherence was 1. Jun 29, 2006 objective to evaluate the relation between adherence to drug therapy, including placebo, and mortality. In medical treatment, the term nonadherence describes the failure of a patient. Hall, phd,t rolande merisca, phd,t beth nordstrom, phd. Liza n takiya, andrew m peterson, and rebecca s finley. Closing the gap with technologymediated interventions treatment nonadherence. Adherence is a crucial point for the success and the safe use of therapies. A metaanalysis of determinants and outcomes of medication adherence in adult solid organ transplantation cynthia l. Factors associated with antihypertensive medication non. A significant barrier to effective medical treatment, however, is the patients failure to follow the recommendations of his or her physician or other healthcare provider. In a collaborative, teambased, care management program for complex patients teamcare, we assessed patient and physician behaviors medication adherence, selfmonitoring, and treatment adjustment in achieving better outcomes for diabetes, coronary heart. Good outcomes from chronic diseases largely depend on the degree of patient adherence to treatment.
Jun 29, 2017 non adherence to antihypertensive medication is the most important cause of uncontrolled blood pressure and is influenced by multiple interrelating factors. Retrieval and summary analysis of r effect sizes and moderators of the relationship between patient adherence and patients. Interventions to enhance medication adherence in chronic. Objective to determine the economic impact of medication nonadherence across multiple disease groups. Metaanalysis was used to synthesize results of 33 published and unpublished randomized controlled trials. Patient adherence and medical treatment outcomes a meta analysis m. A metaanalysis of the association between adherence to drug. As such, objective measures should be used to validate and correlate the subjective ones. A metaanalysis of the association between adherence to drug therapy and mortality. The health and economic consequences of poor adherence have led to many intervention.
Interventions to optimise adherence tend to be more effective if they are tailored to the needs of the individual taking account of the perceptions of the treatment as well as practical. The influence of the patient clinician relationship on healthcare outcomes. Taking into account unfilled prescriptions, missed doses, and inadequate persistence, patient medication adherence averages only 50%. This article summarizes the results of 153 studies published between 1977 and 1994 that evaluated the effectiveness of interventions to improve patient compliance with medical. Assessment on adherence, treatment outcomes or financial burden. Medication persistence refers to the act of continuing the treatment for the prescribed. However, in the fi eld of integrative medicine, the defi nition of adherence goes much deeper. The present study was conducted to determine whether pharmacy claimsbased measures of medication adherence are associated with clinical outcomes in patients with diabetes. Physician communication and patient adherence to treatment.
However, a metaanalysis on adherence outcomes states that a multisubjectivemeasure approach may have higher sensitivity, but not accuracy, over employing a single objective measure. Health beliefs, disease severity, and patient adherence a metaanalysis m. Apr 17, 2007 patients non adherence to medical treatment remains a persistent problem. Objective treatment adherence impact tai is the quantification of the effects of adherence behaviors on medical or psychological outcomes using systematic assessment and analytic methods.
Investigators conducting clinical trials need to appreciate the important role of adherence in clinical research. Assessing patient adherence to chronic diseases treatment. Patient adherence and medical treatment outcomes a meta. Metaanalysis of interventions for medication adherence to. Jul 31, 2017 outcomes included allcause medical costs, acute care resource utilization, and acute complications. Metaanalysis of medical regimen adherence outcomes in pediatric solid organ transplantation. Reviews of this literature indicate that a stronger alliance is associated with better treatment outcomes. Twentysix studies utilizing correlational data were included in the meta analysis. Original article relationship between statin adherence and.
Patient adherence and medical treatment outcomes a metaanalysis. The challenge of patient adherence pubmed central pmc. Ideally the effect of adherence should be measured on an. Metaanalysis of studies of interventions to improve medication adherence revealed an increase in adherence of 411%. Nonadherence is a pervasive underrecognized cause of poor health outcomes. Metaanalysis allows estimates of the overall effects both in correlational research and in experimental interventions involving the training of physicians communication skills. Background approximately 20% to 50% of patients are not adherent to medical therapy. Interventions for improving patients adherence to medical. Effectiveness of interventions to improve patient compliance. Interventions to enhance patient adherence to medication. Barriers to adherence can include a lack of understanding around the medical diagnosis, the need for treatment, or an inability to obtain medication due to cost, scarcity, or time conflicts. Objective to evaluate the relation between adherence to drug therapy, including placebo, and mortality. A metaanalysis of 122 studies reporting associations between social support and patient adherence also suggested that poor social support is a key determinant of nonadherence to medical treatment regimens. Lack of compliance to medical advice is also a source of ongoing frustration to doctors.
The influence of the patientclinician relationship on. For example, in their metaanalysis, martin, garske, and davis 2000 reported a mean alliance outcome correlation of. Health beliefs, disease severity, and patient adherence. A persistent challenge nonadherence to prescribed treatments is a worldwide phenomenon that has been widely recognized for more than. One metaanalysis by wakefield and colleagues15 reported an effect size on medication adherence outcomes from three studies, but the search did not focus on interventions to improve medication adherence. Requests for free electronic copies pdf format only should be sent to. A metaanalysis of determinants and outcomes of medication. Methods specific studies were selected from the treatment adherence literature to illustrate. A metaanalysis adherence is a factor in the outcome of medical treatment, but the. Using metaanalytic procedures to synthesize changes in patientcentered. Fortynine percent of the interventions tested 19 of 39 in 33 studies were associated with statistically significant increases in medication adherence and only 17 reported statistically significant improvements in treatment outcomes. Study results with a negative relationship between adherence and outcomes eg, improved medication adherence was associated with a statistically significant decrease in the quality of the clinical.
Although the literature suggests that assertive community treatment promotes medication adherence 15, 18, little is known about how it achieves these effects. The scope of the study is patient adherence to medical treatment in the cure and care sector. Economic impact of medication nonadherence by disease. A metaanalysis of the association between adherence to. Jul 31, 2012 study results with a negative relationship between adherence and outcomes eg, improved medication adherence was associated with a statistically significant decrease in the quality of the clinical. Interventions to promote adherence to antiretroviral. Medication adherence outcomes of 771 intervention trials. Data synthesis studies were too disparate to warrant metaanalysis.
The relative effectiveness of adherence interventions has been analyzed and. Studies included in the meta analysis had an intervention that was directed at the consumer patient, caregiver, had. Exploratory dichotomous and continuous moderator analyses using meta analytic analogues of anova and regression were performed. Thus, we performed this meta analysis to obtain a better understanding of the relationship between statin adherence and clinical con sequences in patients with cvd. For example, a meta analysis of studies examining social support and patient adherence to medication showed that art adherence was 1. Inadequate medication adherence limits effective treatment for many diseases. Patients nonadherence to medical treatment remains a persistent problem. Medication adherence and improved outcomes among patients. Strategies to measure and improve patient adherence in. Associating medication adherence original research with. Average rates of nonadherence to six areas of the regimen, and correlations of potential risk factors with nonadherence, were calculated. Patientcentered outcomes of medication adherence interventions. In a published meta analysis of the relationship between adherence and outcomes in patients receiving medical treatment including medications and nonpharmacologic management such as dietary restrictions, data were analyzed for 19,000 patients with acute or chronic diseases from 63 eligible studies published over 30 years 1968 to.
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