Table 3.
Evidence for adherence promoting interventions broken down by NCD.
| Interventions promoting adherence | Strength of evidence | Advantages | Limitations |
|---|---|---|---|
| Respiratory disease | |||
| Pharmacist led educational sessions combined with follow-up calls to ensure adherence. | 1 trial (reported in 2 studies) showing evidence for improved adherence and quality of life in COPD patients. | Improvements in adherence and health-related quality of life. Personalized approach possible. Long follow up period (2 years). | Limited cohort (n = 260). No evidence of objective clinical improvements or increased adherence. High risk of methodological bias. |
| Pharmacist educational programmes for parents and children | 1 trial showing evidence for improved asthma control and adherence in pediatric cohorts. | Educational interventions can be beneficial beyond adult populations. Benefits from multi-component, individualized educational interventions from allied-health professionals. | Very limited cohort (n = 40). Moderate follow-up (6 months). No objective clinical improvements found. High risk of methodological bias. |
| T2DM | |||
| Pharmacist patient education | Three trials showed evidence for increased adherence and improved HbA1c and fasting blood glucose after 3–8 months. | Improvements in corresponding subjective adherence and objective clinical parameters. Benefits from both one-off and follow-up interventions seen. | Limited sample sizes (mean = 205). Short follow-up period (mean = 4.75 months). Mixed methodological quality. |
| Reminder-based systems | Two trials that found improvements in medication adherence and HbA1c after 6 month-1 year. | Versatile, cheap programmes based on apps and text messages. Improvements in corresponding subjective adherence and objective clinical parameters. | Limited sample sizes (mean = 153). Moderate follow-up (mean 9 months). Low-mixed methodological quality. Results may not be applicable to those without smartphones or less familiar with technology. |
| MDT-led group self-management educational programme | One trial showing improvements in HbA1c after 6 months. | MDT-approach can provide guidance on adherence as well as lifestyle advice (across exercise, medication use, diet etc.). | Moderate sample size (n = 306) Moderate follow-up (6 months). No evidence of improved adherence measures. Mixed methodological quality. Time and resource intensive intervention. |
| CVD (including stroke, TIA, hypertension) | |||
| Pharmacist patient education | 2 trials looking at hypertension and post-MI finding improvements adherence and CVD clinical parameters over 2–6 months. | Improvements in corresponding adherence and objective clinical parameters. Benefits from one off and follow-up sessions. | Limited sample size (mean = 76). Short follow up (mean = 4 months). Mixed methodological quality. |
| Patient education by CHW | 3 trials looking at hypertension, wider CVD risk factors and ACS patients over 3 mo-1 year with improvements in adherence and clinical parameters. | Improvements in adherence and clinical parameters. Large sample size across multiple regions (mean = 1,618). CHWs can also provide lifestyle advice to improve outcomes. Mixed-high methodological quality. | Moderate follow up (mean = 9 months). Repeated visits required. Mixed improvements in corresponding parameters in individual studies—some effects from lifestyle improvements and need to ensure corresponding optimal pharmacological management. |
| Improved CHW training | One trial looked at improved training for CHWs over 6 months and found no significant improvements in clinical parameters. | Improvements in the number of patients advised to adhere. | Limited cohort (n = 234). Patient adherence was not measured explicitly. Moderate follow up (6 months). Mixed methodological quality. |
| Patient education and follow-up by nurses | One trial looked at nurse teaching, information leaflets and weekly reminders over 6 months and found improvements in adherence | Good methodological quality and improved adherence parameters. | Limited sample size (n = 160). Moderate follow up (6 months). No improvements in clinical outcomes. |
| Fixed dose combination strategies | One trial looked at polypill over 15 months for CVD and found improved adherence and clinical outcomes | Corresponding changes in adherence and clinical parameters. Low cost. Long follow-up (15 months). Large sample size (n = 1000). Good methodological quality. | Only beneficial for those requiring multiple medications. |
| Psychiatry | |||
| Collaborative stepped care model including psychotherapy | 1 trial looked at a combination of psychoeducation, interpersonal psychotherapy and collaborative care management for depression and found improved adherence after 1 month. | Large sample size (n = 2,796). Improved adherence and treatment completion. Many modalities available to improve adherence in stepped fashion for patients with more severe disease. | Short follow up (1 month-90 days). Objective clinical outcomes not assessed. Resource intensive. Moderate methodological quality. |
| CHW education | One trial looking at CHW education and follow-up showing improved adherence over 6 months. | Improved adherence in rural women with major depression | Sample size (n = 250). Moderate follow-up (6 months). No improvements in objective clinical parameters. Poor methodological quality. Need to combine with psychosocial interventions. |
| Renal | |||
| CBT | One trial showing improvements in haemodialysis-related clinical parameters, haemodialysis adherence and drug adherence over 6 months in CKD patients. | Improvements in adherence and clinical parameters. Reduced feeling of hopelessness associated with dialysis. | Limited cohort size (n = 80) Moderate follow-up (6 months). High cost and less scalable. Mixed methodological quality. |
CBT, cognitive behavioral therapy; CHW, community health worker; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular disease; T2DM, type 2 diabetes mellitus; TIA, transient ischaemic attack.