NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
This publication is provided for historical reference only and the information may be out of date.
Closing the Quality Gap: Revisiting the State of the Science (Vol. 4: Medication Adherence Interventions: Comparative Effectiveness)
Evidence Reports/Technology Assessments, No. 208.4
Investigators: Meera Viswanathan, PhD, Carol E Golin, MD, Christine D Jones, MD, MS, Mahima Ashok, PhD, Susan Blalock, MPH, PhD, Roberta C M Wines, MPH, Emmanuel J L Coker-Schwimmer, MPH, Catherine A Grodensky, MPH, David L Rosen, MD, PhD, Andrea Yuen, BS, Priyanka Sista, BA, and Kathleen N Lohr, PhD.
Author Information and AffiliationsStructured Abstract
Objectives:
To assess the effectiveness of patient, provider, and systems interventions (Key Question [KQ] 1) or policy interventions (KQ 2) in improving medication adherence for an array of chronic health conditions. For interventions that are effective in improving adherence, we then assessed their effectiveness in improving health, health care utilization, and adverse events.
Data Sources:
MEDLINE®, the Cochrane Library. Additional studies were identified from reference lists and technical experts.
Review Methods:
Two people independently selected, extracted data from, and rated the risk of bias of relevant trials and systematic reviews. We synthesized the evidence for effectiveness separately for each clinical condition, and within each condition, by type of intervention. We also evaluated the prevalence of intervention components across clinical conditions and the effectiveness of interventions for a range of vulnerable populations. Two reviewers graded the strength of evidence using established criteria.
Results:
We found a total of 62 eligible studies (58 trials and 4 observational studies) from our review of 3,979 abstracts. These studies included patients with diabetes, hyperlipidemia, hypertension, heart failure, myocardial infarction, asthma, depression, glaucoma, multiple sclerosis, musculoskeletal diseases, and multiple chronic conditions. Fifty-seven trials of patient, provider, or systems interventions (KQ 1) evaluated 20 different types of interventions; 4 observational studies and one trial of policy interventions (KQ 2) evaluated the effect of reduced out-of-pocket expenses or improved prescription drug coverage. We found the most consistent evidence of improvement in medication adherence for interventions to reduce out-of-pocket expenses or improve prescription drug coverage, case management, and educational interventions across clinical conditions. Within clinical conditions, we found the strongest support for self-management of medications for short-term improvement in adherence for asthma patients; collaborative care or case management programs for short-term improvement of adherence and to improve symptoms for patients taking depression medications; and pharmacist-led approaches for hypertensive patients to improve systolic blood pressure.
Conclusions:
Diverse interventions offer promising approaches to improving medication adherence for chronic conditions, particularly for the short term. Evidence on whether these approaches have broad applicability for clinical conditions and populations is limited, as is evidence regarding long-term medication adherence or health outcomes.
Contents
- Preface
- Acknowledgments
- Technical Expert Panel
- Peer Reviewers
- Executive Summary
- Introduction
- Methods
- Results
- Introduction
- Results of Literature Searches
- Key Question 1 Patient, Provider, and Systems Interventions
- Key Question 2 Summary of Policy-Level Interventions: Medication Adherence and Other Outcomes
- Key Question 3 Intervention Characteristics and Outcomes for Direct Comparisons of Intervention Characteristics
- Key Question 4 Vulnerable Populations
- Key Question 5 Harms
- Discussion
- References
- Appendix A Search Strategies
- Appendix B Abstract and Full-Text Forms
- Appendix C Excluded Studies
- Appendix D Comprehensive Evidence Tables
- Appendix E Risk of Bias Tables
- Appendix F Adherence and Clinical Outcome Scales Commonly Used in Medication Adherence Studies
- Appendix G Patient, Provider, and Policy Interventions: Summary Evidence Tables
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10056-I, Prepared by: RTI International–University of North Carolina Evidence-based Practice Center, Research Triangle Park, NC
Suggested citation:
Viswanathan M, Golin CE, Jones CD, Ashok M, Blalock S, Wines RCM, Coker-Schwimmer EJL, Grodensky CA, Rosen DL, Yuen A, Sista P, Lohr KN. Medication Adherence Interventions: Comparative Effectiveness. Closing the Quality Gap: Revisiting the State of the Science. Evidence Report No. 208. (Prepared by RTI International–University of North Carolina Evidence-based Practice Center under Contract No. 290-2007-10056-I.) AHRQ Publication No. 12-E010-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm
This report is based on research conducted by the RTI International–University of North Carolina Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10056-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
- 1
540 Gaither Road, Rockville, MD 20850; www
.ahrq.gov
- Review Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review.[Ann Intern Med. 2012]Review Interventions to improve adherence to self-administered medications for chronic diseases in the United States: a systematic review.Viswanathan M, Golin CE, Jones CD, Ashok M, Blalock SJ, Wines RC, Coker-Schwimmer EJ, Rosen DL, Sista P, Lohr KN. Ann Intern Med. 2012 Dec 4; 157(11):785-95.
- Closing the quality gap: revisiting the state of the science (vol. 8: improving health care and palliative care for advanced and serious illness).[Evid Rep Technol Assess (Full ...]Closing the quality gap: revisiting the state of the science (vol. 8: improving health care and palliative care for advanced and serious illness).Dy SM, Aslakson R, Wilson RF, Fawole OA, Lau BD, Martinez KA, Vollenweider D, Apostol C, Bass EB. Evid Rep Technol Assess (Full Rep). 2012 Oct; (208.8):1-249.
- Review Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: An Updated Systematic Review for the U.S. Preventive Services Task Force[ 2018]Review Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: An Updated Systematic Review for the U.S. Preventive Services Task ForceLeBlanc EL, Patnode CD, Webber EM, Redmond N, Rushkin M, O’Connor EA. 2018 Sep
- Review Medication Therapy Management Interventions in Outpatient Settings[ 2014]Review Medication Therapy Management Interventions in Outpatient SettingsViswanathan M, Kahwati LC, Golin CE, Blalock S, Coker-Schwimmer E, Posey R, Lohr KN. 2014 Nov
- Review Closing the quality gap: revisiting the state of the science (vol. 3: quality improvement interventions to address health disparities).[Evid Rep Technol Assess (Full ...]Review Closing the quality gap: revisiting the state of the science (vol. 3: quality improvement interventions to address health disparities).McPheeters ML, Kripalani S, Peterson NB, Idowu RT, Jerome RN, Potter SA, Andrews JC. Evid Rep Technol Assess (Full Rep). 2012 Aug; (208.3):1-475.
- Closing the Quality Gap: Revisiting the State of the Science (Vol. 4: Medication...Closing the Quality Gap: Revisiting the State of the Science (Vol. 4: Medication Adherence Interventions: Comparative Effectiveness)
- Costs and Benefits of Health Information TechnologyCosts and Benefits of Health Information Technology
- Enabling Patient-Centered Care Through Health Information TechnologyEnabling Patient-Centered Care Through Health Information Technology
- Omega-3 Fatty Acids and Cardiovascular DiseaseOmega-3 Fatty Acids and Cardiovascular Disease
- Milk Thistle: Effects on Liver Disease and Cirrhosis and Clinical Adverse Effect...Milk Thistle: Effects on Liver Disease and Cirrhosis and Clinical Adverse Effects
Your browsing activity is empty.
Activity recording is turned off.
See more...