SYSTEMATIC REVIEW OF RANDOMIZED TRIALS OF INTERVENTIONS TO ASSIST PATIENTS TO FOLLOW PRESCRIPTIONS FOR MEDICATIONS

Background Low adherence of patients to prescribed, self-administered medical interventions is ubiquitous. Low adherence limits the benefits of current medical care. Efforts to assist patients to follow treatme nts might improve the efficiency of care and substantially enhance ben efits. Our objective was to summarise the results of randomised contro lled trials (RCTs) of interventions to help patients follow prescripti ons for medications. Methods A previous systematic review was updated through computerised searches in Medline, International Pharmaceutical Abstracts, Psychinfo, and HSTAR online databases; bibliographies in a rticles on patient adherence; articles in the reviewers' personal coll ections; and contact with authors. Articles were judged of interest if they reported original data concerning an unconfounded RCT of an inte rvention to improve adherence with prescribed medications, with one or more measure of medication adherence, one or more measure of treatmen t outcome, at least 80% follow-up of each group studied, and, for long term treatments, at least 6 months of follow-up for studies with posit ive initial findings. Information on study design features, interventi ons and controls, and findings were extracted by one reviewer (RK) and checked by the other two reviewers. Findings 1553 relevant citations and abstracts were screened, 252 full text articles were reviewed in d etail, and 13 RCTs met all criteria. The studies were too disparate in clinical problems, adherence interventions, measures and reporting of adherence, and the clinical outcomes studied to warrant meta-analysis . Seven of 15 interventions were associated with improvements in adher ence and six interventions led to improvements in treatment outcomes. For short-term treatments, one study showed an effect on adherence and outcome of counselling and written information. The interventions tha t were effective for long term care were complex, including various co mbinations of more convenient care, information, counselling, reminder s, self-monitoring, reinforcement, family therapy, and other forms of additional supervision or attention. Even the most effective intervent ions did not lead to substantial improvements in adherence. Interpreta tion Although adherence and treatment outcomes can be improved by cert ain-usually complex-interventions, full benefits of medications cannot be realised at currently achievable levels of adherence. It is time t hat additional efforts be directed towards developing and testing inno vative approaches to assist patients to follow treatment prescriptions .