Table 1.
Author, Year, Site | Participants, Duration | Intervention | Adherence Measures | Outcomes |
---|---|---|---|---|
Paper information: mailed, faxed or handed out | ||||
Smith, 2008 U.S. urban centers | 907 patients at hospital discharge post-MI, with β-blocker prescriptions 9 months |
2 mailings to patients, PCP’s addressing importance of β-blockers, guidelines. | % of patients with ≥80% of days covered in the 9 months after 1st mailing; pharmacy claims and other electronic data. | Treatment patients were 17% more likely to have 80% of days covered (RR 1.17; CI 1.02 -1.29) |
Takala, J, 1983 Southwest Finland | 147 untreated HTN patients 2 years |
Mailed information on HTN | 2 years after intervention, asked if “still under treatment after 2 years.” | Adherent: I: 90% C: 79% P=NS |
Video information: mailed or handed out | ||||
Powell, KM, 1995 | 4246 patients on benzapril, metoprolol, simvastatin or estrogen. 9 months |
Mailed 1 of 4 educational videotapes | MPR; pharmacy claims | No significant between-group differences in mean MPRs. |
Electronic system | ||||
Emmett, CL, 2005 Bristol, England. | 217 newly diagnosed HTN patients, primary care practices 3 years |
|
Proportion of patients who report taking all their medications. | DA: 90% Adjusted OR 1.56, CI 0.49-4.96, p=0.45 Video plus leaflet: 94% Adjusted OR 0.53, CI 0.15 -1.84, p=0.32 |
Friedman, 1996 Boston | 299 HTN patients. 6 months |
Interactive computer-based home monitoring. Patient self-BP checks, weekly calls to counsel on adherence. | MPR (expressed as percent); home pill count | Mean Δ adherence, unadjusted: C: - 0.4% I: +2.4% p=0.29 Adjusted for baseline adherence: I: 17.7% C: 11.7% p =0.03 |
Johnson, SS, 2006 Massachusetts and Rhode Island | 404 adults with hyperlipidemia. 18 months |
Population-based, computer-generated individualized intervention; report mailed to patient | Responses to 5 questions (on Likert scale) summed to create a continuous measure. Calculated Odds of appropriate adherence; Self-report | Adherence as continuous measure: 6 months OR 2.03 p>0.05 18 months OR 2.86 p<0.05 |
Marquez-Contreras, 2006 Spain | 250 HTN patients from primary care centers 6 months |
Home automatic BP monitoring | MPR (expressed as %); Adherent is >80%; MEMS | % of adherent patients I: 92 (SD 14.2) C: 74 (SD 18.1) P = 0.0007 |
Piette, 2000 | 280 DM patients on hypoglycemic medications. Included Spanish-speaking patients. 12 months |
Biweekly automated assessment/ education calls: hierarchically structured messages (positive feedback for adherence, questions on adherence barriers, advice); targeted nurse follow-up calls. | Abbreviated Morisky Index. Patients considered nonadherent if they sometimes forgot or stopped taking medication. Phone interviews, self-report. | I: “substantially less likely” to report adherence problems (P=0.003). |
Rosen, 2004 Connecticut | 33 DM patients on metformin with <80% adherence 28 weeks |
Cue-dose training: given electronic pill caps programmed to beep, instruction on other cues. | Mean MPR (doses needed to be taken on time); electronic pill bottles | 16 weeks of intervention: I: 80% C: 60% p = 0.017 No numbers given for 28 weeks (graph provided) |
Controls received usual care unless otherwise specified. Duration indicates time until last follow up in which adherence is measured. Confidence interval (CI) is 95% unless otherwise specified.
Unless country is otherwise indicated, study took place in United States.
HTN = hypertension; BP = Blood pressure; CHF = Congestive heart failure; MI = Myocardial Infarct; MEMS = Medication Electronic Monitoring System; PCP = Primary Care Practitioner; MPR = Medication Possession Ratio, medication doses taken divided by doses prescribed. “Morisky scale” has 4 questions: 1 pt for every ‘yes” response. 1.Do you ever forget to take your medication? 2.Are you careless at times about taking your medication? 3. When you feel better, do you sometimes stop taking your medication? 4. Sometimes if you feel worse when you take your medication, do you stop taking it? I = Intervention group; C=control group