Multiple interventions offer pathways to improved medication adherence
Patient Safety and Quality
Nearly half of medications for chronic conditions, such as hypertension, are not taken according to directions. What’s more, 20 to 30 percent of prescriptions are never filled. Policy-level interventions, such as reduced copayments improve adherence across a variety of clinical conditions. At the patient level, case management, education, and behavioral support also help with medication adherence, according to a new study.
Researchers conducted a systemic review of the literature to identify interventions that improve medication adherence. Included in the analysis were 73 articles that featured 62 trials investigating 18 types of patient, provider, or system-level interventions. There were also four observational studies and one additional trial that looked at the impact of policy interventions on reducing medication copayments and improving drug coverage for patients.
Effective interventions ranged from simple strategies such as patient mailings to elaborate programs featuring case management and multidisciplinary care. More than half of the 62 trials (53 percent) did show improved outcomes in medication adherence. Many interventions were likely to be complex and address multiple pathways for change.
Although researchers found evidence that several interventions improve medication adherence, not all effective interventions were proven to work for all clinical conditions. Interventions that improve adherence across multiple clinical conditions include policy interventions to reduce copayments or improve prescription drug coverage, systems interventions to offer case management, and patient-level educational interventions with behavioral support. However, interventions such as collaborative care seemed to work best for a specific condition (depression or depression and diabetes).
Certain interventions, such as virtual clinics and blister packaging, have not yet been tested in a range of clinical conditions. Therefore, while virtual clinics and blister packaging may appear to be effective for one condition, it is not yet clear if they work for other conditions.
The researchers call for more studies to examine which interventions can improve medication adherence long-term. The study was supported in part by AHRQ (Contract No. 290-07-10056).
See "Interventions to improve adherence to self-administered medications for chronic diseases in the United States," by Meera Viswanathan, Ph.D., Carol E. Golin, M.D., Christine D. Jones, M.D., M.S., and others in the December 4, 2012, Annals of Internal Medicine 157(11), pp. 785-795.