Table 3.
General Characteristics of Tools Focusing on Medication Adherence
| Tool | Primary Study (Year Published) |
Systematic Review and Monthsdified Evidence GRADE | Primary Study Characteristics | Study Measurement Methods | Results | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Setting (Country) | Follow-up Duration | Patient Population | Who Used Tool? | No. Subjects (I/C) | Data Source | Outcome Variable | ||||
| Interventions Focused on Medication Adherence in General | ||||||||||
| 1. Telephone reminder timeline with 4 parts: medication reconciliation and tailoring + patient education + collaborative care between pharmacist and PCP and/or cardiologist + voice messaging | Lambert-Kerzner et al (2012)8 | van Driel et al (2016) Moderate |
Postdischarge (United States) |
12 months | Adults with acute coronary syndrome | Pharmacist | 140/140 | Pharmacy refill data on cardioprotective medications | Modified medication possession ratio for each medication (no. days medication supplied/observation time interval) | Significantly better adherence to medication regimens in intervention group vs control group (89.3% vs 73.9%, P = 0.003) |
| 2. Telephone reminder script: automated call from provider organization that prompted patient to get newly prescribed statin 1–2 weeks after visit (if medication not picked up within 1 weeks of call, a letter was sent) | Derose et al (2013)9 | van Driel et al (2016) Moderate |
Postdischarge (United States) |
25 days | Adults with dyslipidemia | Provider organization | 2,606/2,610 | Medication dispensations from healthcare pharmacies | Dispensation of statin between first phone call and up to 2 weeks after letter was delivered (25 days) | Significantly better postdischarge statin dispensation in intervention group vs control group (42.3% vs 26.0%; absolute difference, 16.3%; P < 0.001) |
| Interventions Focused on Medication Adherence for Patients with Comonthsrbid Depression | ||||||||||
| 3. Flowchart for managing depression and hypertension: in-person and telephone conversations discussing depression and effect on antihypertensive medication adherence | Bogner et al (2008)10,a | Viswanathan et al (2012) Low |
Outpatient (United States) |
6 weeks | Adults 50-80 years of age with HTN and depression | Integrated care manager | 32/32 | MEMS caps | Adherence: 80% or more of pills taken during specified observation period | Significantly better adherence to antidepressant medication (71.9% vs 31.3%, P < 0.01) and antihypertensive medication (78.1% vs 31.3%, P < 0.001) in intervention group vs control group |
| Interventions Addressing Medication Adherence with Communication or Patient Education | ||||||||||
| 4. Pharmacist-delivered adherence monitoring service: BMQ/MARS/BMU questionnaires + SF12 quality of life questionnaire + 21 food frequency checklist and exercise survey | Aslani et al (2010)12 | Rash et al (2016) Very low |
Outpatient (Australia) |
12 months | Adults with dyslipidemia | Pharmacist | 48/49 | MARS | MARS | At the second study visit, 3 months after the initial visit, patients were less likely to take a decreased amount of the prescribed dose (F2,178 = 4.3, P < 0.05; contrast F1,89 = 5.7, P < 0.05) |
| 5. Motivational interviewing script: 4 motivational interview sessions every 3 months for 12 months | Ogedegbe et al (2008)13 Primary study |
Easthall et al (2013) Very low |
Outpatient (United States) |
12 months | African American adults with HTN | Research assistant | 95/95 | MEMS caps | Taking adherence: proportion of days in which the patient took the prescribed medication | Significantly better posttreatment adherence rates in intervention group vs control group (57% vs 43%, P = 0.027) |
| 6. Pharmacist patient education protocol: baseline medication history with patient-centered verbal/written instructions + collaborative care with PCP and/or nurse | Murray et al (2007)14 | Demonceau et al (2013) Very low |
Outpatient (United States) |
12 months | Low-income adults ≥50 years of age with heart failure | Pharmacist | 122/192 | MEMS caps | Adherence: % of prescribed medication taken | Overall medication adherence was significantly better in intervention group vs control (78.8% vs 67.9%; absolute difference, 10.9%; 95% CI, 5.0-16.7) |
| Interventions Addressing Medication Adherence with SMS Text Messages | ||||||||||
| 7. SMS text message scripts for asthma: SMS text messages that were tailored to each patient based on BIPQ responses at baseline | Petrie et al (2012)15 | Tao et al (2015) Low |
Outpatient (New Zealand) |
9 mo | Adults and adolescents (16-45 years of age) with asthma | A bank of 166 text messages tailored for asthmatic patients | 73/74 | Self-report | BIPQ Adherence: 80% or greater of taking medication |
Significant improvement in SMS group in perception of medication necessity, nature of patient’s asthma, and patient’s control of asthma (P < 0.05); significantly higher percentage of SMS group vs control group took 80% of their inhaler doses (37.7% vs 23.9%, P < 0.05) |
| 8. SMS text message scripts for type 1 diabetes: SweetTalk Software System (motivational SMS text messages) | Franklin et al (2006)16 | Tao et al (2015) Low |
Outpatient (United Kingdom) |
12 months | Pediatric patients with type 1 diabetes | Automated system with over 400 text messages | 33/28 | Self-report | Visual analogue adherence score | Significantly better adherence in the intervention group vs control group (mean [SD], 77.2 [16.1] vs 70.4 [20.0], P = 0.042) |
| Interventions Addressing Medication Adherence with Communication or Patient Education | ||||||||||
| 9. Pharmacist-delivered adherence monitoring service: BMQ/MARS/BMU questionnaires + SF12 quality of life questionnaire + 21 food frequency checklist and exercise survey | Aslani et al (2010)12 | Rash et al (2016) Very low |
Outpatient (Australia) |
12 months | Adults with dyslipidemia | Pharmacist | 48/49 | MARS | MARS | At second study visit, which occurred 3 mo after the initial visit, patients were less likely to take a decreased amount of the prescribed dose (F2,178 = 4.3, P < 0.05; contrast F1,89 = 5.7, P < 0.05) |
| 10. Motivational interviewing script: 4 motivational interview sessions every 3 mo for 12 mo | Ogedegbe et al (2008)13 Primary study |
Easthall et al (2013) Very low |
Outpatient (United States) |
12 months | African-American adults with HTN | Research assistant | 95/95 | MEMS caps | Taking adherence (proportion of days on which the patient took the prescribed medication) | Significantly better posttreatment adherence rates in intervention group vs control group (57% vs 43%, P = 0.027) |
| 11. Pharmacist patient education protocol: baseline medication history with patient-centered verbal/written instructions + collaborative care with PCP/nurse | Murray et al (2007)14 | Demonceau et al (2013) Very low |
Outpatient (United States) |
12 months | Low-income adults age ≥50 years with heart failure | Pharmacist | 122/192 | MEMS caps | Adherence (percentage of prescribed medication taken) | Overall medication adherence was significantly better in intervention group vs control group (78.8% vs 67.9%; absolute difference, 10.9%; 95% CI, 5.0-16.7) |
| Interventions Addressing Medication Adherence with SMS Text Messages | ||||||||||
| 12. SMS text message scripts for asthma: SMS text messages that were tailored to each patient based on BIPQ responses at baseline | Petrie et al (2012)15 | Tao et al (2015) Low |
Outpatient (New Zealand) |
9 months | Adults and adolescents (16-45 years of age) with asthma | A bank of 166 text messages tailored for asthmatic patients | 73/74 | Self-report | BIPQ Adherence: 80% or greater of taking medication |
Significant improvement in SMS group in perception of medication necessity, nature of patient’s asthma, and patient’s control of asthma (P < 0.05); significantly higher percentage of SMS group vs control group took 80% of their inhaler doses (37.7% vs 23.9%, P < 0.05) |
| 13. SMS text message scripts for type 1 diabetes: SweetTalk Software System (motivational SMS text messages) | Franklin et al (2006)16 | Tao et al (2015) Low |
Outpatient (United Kingdom) |
12 months | Pediatric patients with type 1 diabetes | Automated system with over 400 text messages | 33/28 | Self-report | Visual analogue adherence score | Significantly better adherence in the intervention group vs control group (mean [SD], 77.2 [16.1] vs 70.4 [20.0], P = 0.042) |
Abbreviations: BIPQ, Brief Illness Perception Questionnaire; BMQ, Brief Medication Questionnaire; BMU, Barriers to Medication Use Questionnaire; CI, confidence interval; GRADE, Grading of Recommendations Assessment, Development and Evaluation5; MARS, Medication Adherence Report Scale; MEMS, Medication Event Monitoring System; PCP = primary care provider; SD, standard deviation; SF12, 12-item Short Form Survey; SMS, short message service.
aIntervention methods also discussed in reference 11.