Welcome to the last article in our series on medication nonadherence. We’ve examined the scope of the problem; looked at several ways physicians and health care providers can reduce the incidence of nonadherence; and addressed the key role played by the pharmacological community. If you’ve been following along the entire time, thank you! However, you might understandably be wondering, do these interventions actually work? Studies have shown that certain medication adherence interventions do work.
- A retrospective cohort study of 2,056 new-to-therapy patients beginning statin treatment looked at the effect of a community-based, pharmacist-led face-to-face counseling program. After 12 months, researchers saw a 4.9 percent increase in adherence for this group, in which patients were significantly more likely to continue therapy.
- In a randomized investigatory blind trial of managed problem solving, 91 patients with HIV were assigned to the intervention group and 89 to usual care. Those in the intervention group were significantly more adherent to antiretroviral therapy and more likely to have an undetectable viral load. Intervention was equally effective among experienced and naïve patients, and did not lose effect over time.
- In a randomized controlled trial of 46 patients with depression, 21 received an intervention that offered active patient engagement and collaborative care management using web- and mobile-based information and communication technology, plus care managers known as Improvehealth.eu. After six months, adherence to antidepressant medications was significantly higher in the intervention group than in controls (83 percent vs. 33 percent), and these patients showed fewer depressive symptoms.
At the same time, there are missed results reported for medication adherence interventions. Meta-analyses and systematic reviews looked at the evidence from many studies. A 2012 review in the Annals of Internal Medicine of 18 interventions studied in 62 trials found that about half reported improvement in medication adherence. The best results were seen for educational interventions combined with behavior support through continued patient contact. Reduced out-of-pocket expenses and case management also proved helpful. However, relatively little evidence was found linking higher adherence to better clinical outcomes. A meta-analysis of 79 clinical trials involving adherence-enhancing interventions using electronically compiled drug-dosing histories found that interventions improved adherence by about 14 percent, and interventions that included patient feedback on dosing or had cognitive-educational components were most effective. A review looking at 20 studies of interventions to improve osteoporosis medication adherence found simplification of dosing regimens, decision aids, electronic prescription, and patient education all promoted adherence.
What emerges here is the fact that the impact of intervention on medication adherence is an active area of research. Reviews generally indicate that there is a wide variation in the strategies used and in the quality of the studies. Evidence suggests that there is no “magic bullet” solution for adherence for all diseases and situations. For the physician, the challenge is to identify the combination of interventions that will best meet the needs of patients while practicing within the constraints of time and budget.
Thanks again for reading our eight-part series on medication adherence and nonadherence. We hope that these articles will help facilitate improved dialogue between patients, doctors, pharmacists and health care systems on this critical issue, so that we can all live happier, healthier lives.