A critical review of interventions to increase compliance with medication-taking, obtaining medication refills, and appointment-keeping in the treatment of cardiovascular disease

Background. The aim of this study was to critically review the literature r egarding interventions to improve cardiovascular patients' compliance with medication-taking, obtaining medication refills, or appointment keeping. Methods. The search for relevant randomized trials involved searching the M edline, Healthplan, and Psychlit databases from 1985 to 1996; searching the bibliographies of located studies; contacting Australian government depart ments, nongovernment organizations, and pharmaceutical companies; and ultim ate review of the resulting list by two field experts. The 33 located trial s were critically appraised and classified as being of good, fair, or poor methodological quality. Descriptive and effectiveness data were then extrac ted from the 20 good and fair quality trials. Interrater reliability was hi gh on the 20% of references double-coded. Results. The 20 studies reviewed evaluated the effectiveness of 18 interven tion strategies. Tentative recommendations were made for many patient-focus ed and structural strategies across all three target behaviors. Physician-f ocused strategies, tested only for appointment keeping, were all tentativel y recommended against. Conclusions. The methodological quality of many of the located trials was l ess than optimal, prohibiting strong recommendations. Therefore, further go od-quality, randomized trials are necessary in order to clarify the effecti veness of those strategies identified as potentially useful in this review, (C) 1999 American Health Foundation and Academic Press.