Targeting cardiovascular medication adherence interventions
Department of Medicine; Meyers Primary Care Institute
Health Services Research | Primary Care
OBJECTIVES: To determine whether adherence interventions should be administered to all medication takers or targeted to nonadherers.
DATA SOURCES AND STUDY SELECTION: Systematic search (Medline and Embase, 1966-2009) of randomized controlled trials of interventions to improve adherence to medications for preventing or treating cardiovascular disease or diabetes.
DATA EXTRACTION: Articles were classified as (1) broad interventions (targeted all medication takers), (2) focused interventions (targeted nonadherers), or (3) dynamic interventions (administered to all medication takers; real-time adherence information targets nonadherers as intervention proceeds). Cohen's d effect sizes were calculated.
DATA SYNTHESIS: We identified 7,190 articles; 59 met inclusion criteria. Broad interventions were less likely (18%) to show medium or large effects compared with focused (25%) or dynamic (32%) interventions. Of the 33 dynamic interventions, 6 used externally generated adherence data to target nonadherers. Those with externally generated data were less likely to have a medium or large effect (20% vs. 34.8% self-generated data).
CONCLUSION: Adherence interventions targeting nonadherers are heterogeneous but may have advantages over broad interventions. Dynamic interventions show promise and require further study.
DOI of Published Version
J Am Pharm Assoc (2003). 2012 May-Jun;52(3):381-97. DOI:10.1331/JAPhA.2012.10211
J Am Pharm Assoc (2003)
Cutrona SL, Choudhry NK, Fischer MA, Servi A, Stedman MR, Liberman JN, Brennan T, Shrank WH. (2012). Targeting cardiovascular medication adherence interventions. Meyers Primary Care Institute Publications. https://doi.org/10.1331/JAPhA.2012.10211. Retrieved from https://escholarship.umassmed.edu/meyers_pp/590