Patient adherence to medical treatment: a review of reviews

Sandra van Dulmen, Emmy Sluijs, Liset van Dijk, Denise de Ridder, Rob Heerdink, Jozien Bensing, Sandra van Dulmen, Emmy Sluijs, Liset van Dijk, Denise de Ridder, Rob Heerdink, Jozien Bensing

Abstract

Background: Patients' non-adherence to medical treatment remains a persistent problem. Many interventions to improve patient adherence are unsuccessful and sound theoretical foundations are lacking. Innovations in theory and practice are badly needed. A new and promising way could be to review the existing reviews of adherence to interventions and identify the underlying theories for effective interventions. That is the aim of our study.

Methods: The study is a review of 38 systematic reviews of the effectiveness of adherence interventions published between 1990 and 2005. Electronic literature searches were conducted in Medline, Psychinfo, Embase and the Cochrane Library. Explicit inclusion and exclusion criteria were applied. The scope of the study is patient adherence to medical treatment in the cure and care sector.

Results: Significant differences in the effectiveness of adherence interventions were found in 23 of the 38 systematic reviews. Effective interventions were found in each of four theoretical approaches to adherence interventions: technical, behavioural, educational and multi-faceted or complex interventions. Technical solutions, such as a simplification of the regimen, were often found to be effective, although that does not count for every therapeutic regimen.Overall, our results show that, firstly, there are effective adherence interventions without an explicit theoretical explanation of the operating mechanisms, for example technical solutions. Secondly, there are effective adherence interventions, which clearly stem from the behavioural theories, for example incentives and reminders. Thirdly, there are other theoretical models that seem plausible for explaining non-adherence, but not very effective in improving adherence behaviour. Fourthly, effective components within promising theories could not be identified because of the complexity of many adherence interventions and the lack of studies that explicitly compare theoretical components.

Conclusion: There is a scarcity of comparative studies explicitly contrasting theoretical models or their components. The relative weight of these theories and the effective components in the interventions designed to improve adherence, need to be assessed in future studies.

References

    1. Cochrane MG, Bala MV, Downs KE, Mauskopf J, Ben Joseph RH. Inhaled corticosteroids for asthma therapy: patient compliance, devices, and inhalation technique. Chest. 2000;117:542–550. doi: 10.1378/chest.117.2.542.
    1. Gibson PG. Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev. 2001.
    1. Haddad M, Inch C, Glazier RH, Wilkins AL, Bayoumi A, Rourke S. Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS. Cochrane Database Syst Rev. 2000. pp. 1–10.
    1. Hampson SE, Skinner TC, Hart J, Storey L, Gage H, Foxcroft D, Kimber A, Shaw K, Walker J. Effects of educational and psychosocial interventions for adolescents with diabetes mellitus: a systematic review. Health Technol Assess. 2001;5:1–79.
    1. Lorig K, Holmann H. Arthritis self-management studies: a twelve year review. Health Educ Q. 1993;20:17–28.
    1. Haynes R, Yao X, Degani A, Kripalani S, Garg A, McDonald H. Interventions to enhance medication adherence. Cochrane Database Syst Rev. 2005. pp. 1–96.
    1. Burke LE, Ockene IS. Compliance in Healthcare and Research. Armonk, NY: Furtura; 2001.
    1. Einarson TR. Drug-related hospital admissions. Ann Pharmacother. 1993;27:832–840.
    1. Burke LE, Dunbar-Jacob JM, Hill MN. Compliance with cardiovascular disease prevention strategies: a review of the research. Ann Behav Med. 1997;19:239–263.
    1. Bunzel B, Laederach-Hofmann K. Solid organ transplantation: Are there predictors for posttransplant noncompliance? A literature overview. Transplantation. 2000;70:711–716. doi: 10.1097/00007890-200009150-00001.
    1. Cramer JA, Rosenheck R. Compliance with medication regimens for mental and physical disorders. Psychiatr Serv. 1998;49:196–201.
    1. Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care. 2004;27:1218–1224. doi: 10.2337/diacare.27.5.1218.
    1. DiMatteo MR. Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42:200–209. doi: 10.1097/01.mlr.0000114908.90348.f9.
    1. Lacro JP, Dunn LB, Dolder CR, Leckband SG, Jeste DV. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: A comprehensive review of recent literature. J Clin Psychiatry. 2002;63:892–909.
    1. Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001;23:1296–1310. doi: 10.1016/S0149-2918(01)80109-0.
    1. Sabaté E. Adherence to long-term therapies Evidence for action. Geneva, Switzerland: WHO; 2003.
    1. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487–497. doi: 10.1056/NEJMra050100.
    1. Awad AG. Antipsychotic medications: Compliance and attitudes towards treatment. Curr Opin Psychiatry. 2004;17:75–80. doi: 10.1097/00001504-200403000-00002.
    1. McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: Scientific review. JAMA. 2002;288:2868–2879. doi: 10.1001/jama.288.22.2868.
    1. Dunbar JJ, Dwyer K, Dunning EJ. Compliance with antihypertensive regimen: A review of the research in the 1980s. Ann Behav Med. 1991;13:31–39.
    1. Haynes RB. Patient compliance then and now. Patient Educ Couns. 1987;10:103–105. doi: 10.1016/0738-3991(87)90091-7.
    1. Loghman-Adham M. Medication noncompliance in patients with chronic disease: issues in dialysis and renal transplantation. Am J Manag Care. 2003;9:155–171.
    1. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research: a comprehensive review. J Clin Pharm Ther. 2001;26:331–342. doi: 10.1046/j.1365-2710.2001.00363.x.
    1. Armitage ChJ, Conner M. Social cognition models and health behaviour: a structured review. Psychology & Health. 2000;15:173–189.
    1. Kaptein A, Weinman J. Health Psychology. Malden: BPS Blackwell; 2004.
    1. Sluijs EM, Knibbe JJ. Patient compliance with exercise: Different theoretical approaches to short-term and long-term compliance. Patient Educ Couns. 1991;17:191–204. doi: 10.1016/0738-3991(91)90060-I.
    1. Bender B, Milgrom H, Apter A. Adherence intervention research: What have we learned and what do we do next? Journal Allergy Clin Immunol. 2003;112:489–494. doi: 10.1016/S0091-6749(03)01718-4.
    1. Peterson AM, Takiya L, Finley R. Meta-analysis of trials of interventions to improve medication adherence. Am J Health Syst Pharm. 2003;60:657–665.
    1. Peterson AM, Takiya L, Finley R. Meta-analysis of interventions to improve drug adherence in patients with hyperlipidemia. Pharmacotherapy. 2003;23:80–87. doi: 10.1592/phco.23.1.80.31921.
    1. Takiya LN, Peterson AM, Finley RS. Meta-analysis of interventions for medication adherence to antihypertensives. Ann Pharmacother. 2004;38:1617–1624. doi: 10.1345/aph.1D268.
    1. Roter DL, Hall JA, Merisca R, Nordstrom B, Cretin D, Svarstad B. Effectiveness of interventions to improve patient compliance: a meta-analysis. Med Care. 1998;36:1138–1161. doi: 10.1097/00005650-199808000-00004.
    1. Special report: interventions to improve patient adherence with medications for chronic cardiovascular disorders. TEC Bull (Online) 2003;20:30–32.
    1. Dinnes J, Kleijnen J, Leitner M, Thompson D. Cardiac rehabilitation. Qual Health Care. 1999;8:65–71.
    1. Greenhalgh T. How to read a paper: papers that summarise other papers (systematic reviews and meta-analysis) BMJ. 1997;315:672–673.
    1. Dodds F, Rebair-Brown APS. A systematic review of randomized controlled trials that attempt to identify interventions that improve patient compliance with prescribed antipsychotic medication. Clin Effect Nurs. 2000;4:47–53. doi: 10.1054/cein.2000.0110.
    1. Buring SM, Winner LH, Hatton RC, Doering PL. Discontinuation rates of Helicobacter pylori treatment regimens: a meta-analysis. Pharmacotherapy. 1999;19:324–332. doi: 10.1592/phco.19.4.324.30939.
    1. Connor J, Rafter N, Rodgers A. Do fixed-dose combination pills or unit-of-use packaging improve adherence? A systematic review. Bull World Health Organ. 2004;82:935–939.
    1. Iskedjian M, Einarson TR, MacKeigan LD, Shear N, Addis A, Mittmann N, Ilersich AL. Relationship between daily dose frequency and adherence to antihypertensive pharmacotherapy: evidence from a meta-analysis. Clin Ther. 2002;24:302–316. doi: 10.1016/S0149-2918(02)85026-3.
    1. Richter A, Anton SE, Koch P, Dennett SL. The impact of reducing dose frequency on health outcomes. Clin Ther. 2003;25:2307–2335. doi: 10.1016/S0149-2918(03)80222-9.
    1. Yildiz A, Pauler DK, Sachs GS. Rates of study completion with single versus split daily dosing of antidepressants: a meta-analysis. J Affect Disord. 2004;78:157–162. doi: 10.1016/S0165-0327(02)00300-2.
    1. Morrison A, Wertheimer AI, Berger ML. Interventions to improve antihypertensive drug adherence: A quantitative review of trials. Formulary. 2000;35:234–255.
    1. Giuffrida A, Torgerson DJ. Should we pay the patient? Review of financial incentives to enhance patient compliance. BMJ. 1997;315:703–707.
    1. Macharia WM, Leon G, Rowe BH, Stephenson BJ, Haynes RB. An overview of interventions to improve compliance with appointment keeping for medical services. JAMA. 1992;267:1813–1817. doi: 10.1001/jama.267.13.1813.
    1. Van Eijken M, Tsang S, Wensing M, De Smet PA, Grol RP. Interventions to improve medication compliance in older patients living in the community: A systematic review of the literature. Drugs Aging. 2003;20:229–240. doi: 10.2165/00002512-200320030-00006.
    1. Brown SA. Studies of educational interventions and outcomes in diabetic adults: A meta-analysis revisited. Patient Educ Couns. 1990;16:189–215. doi: 10.1016/0738-3991(90)90070-2.
    1. Devine EC. Meta-analysis of the effects of psychoeducational care in adults with asthma. Res Nurs Health. 1996;19:367–376. doi: 10.1002/(SICI)1098-240X(199610)19:5<367::AID-NUR1>;2-O.
    1. Devine EC, Reifschneider E. A meta-analysis of the effects of psychoeducational care in adults with hypertension. Nurs Res. 1995;44:237–245. doi: 10.1097/00006199-199507000-00009.
    1. Zygmunt A, Olfson M, Boyer CA, Mechanic D. Interventions to improve medication adherence in schizophrenia. Am J Psychiatry. 2002;159:1653–1664. doi: 10.1176/appi.ajp.159.10.1653.
    1. Schroeder K, Fahey T, Ebrahim S. Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings. Cochrane Database Syst Rev. 2004. pp. 1–25.
    1. Vergouwen AC, Bakker A, Katon WJ, Verheij TJ, Koerselman F. Improving adherence to antidepressants: a systematic review of interventions. J Clin Psychiatry. 2003;64:1415–1420.
    1. Mullen PD, Mains DA, Velez RA. A meta-analysis of controlled trials of cardiac patient education. Patient Educ Couns. 1992;19:143–162. doi: 10.1016/0738-3991(92)90194-N.
    1. DiMatteo MR. Social support and patient adherence to medical treatment: A meta-analysis. Health Psychol. 2004;23:207–218. doi: 10.1037/0278-6133.23.2.207.
    1. Dolder CR, Lacro JP, Leckband S, Jeste DV. Interventions to improve antipsychotic medication adherence: review of recent literature. J Clin Psychopharmacol. 2003;23:389–399. doi: 10.1097/01.jcp.0000085413.08426.41.
    1. Merinder LB. Patient education in schizophrenia: a review. Acta Psychiatr Scand. 2000;102:98–106. doi: 10.1034/j.1600-0447.2000.102002098.x.
    1. Nose M, Barbui C, Gray R, Tansella M. Clinical interventions for treatment non-adherence in psychosis: meta-analysis. Br J Psychiatry. 2003;183:197–206. doi: 10.1192/bjp.183.3.197.
    1. Van Dam HA, Van der Horst F, Van den Borne B, Ryckman R, Crebolder H. Provider-patient interaction in diabetes care: effects on patient self-care and outcomes: a systematic review. Patient Educ Couns. 2003;51:17–28. doi: 10.1016/S0738-3991(02)00122-2.
    1. Vermeire E, Wens J, Van Royen P, Biot Y, Hearnshaw H, Lindenmeyer A. Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2005. pp. 1–37.
    1. Schedlbauer A, Schroeder K, Peters TJ, Fahey T. Interventions to improve adherence to lipid lowering medication. Cochrane Database Syst Rev. 2004. pp. 1–28.
    1. Higgins N, Regan C. A systematic review of the effectiveness of interventions to help older people adhere to medication regimes. Age Ageing. 2004;33:224–229. doi: 10.1093/ageing/afh072.
    1. Sharp J, Wild MR, Gumley AI. A systematic review of psychological interventions for the treatment of nonadherence to fluid-intake restrictions in people receiving hemodialysis. Am J Kidney Dis. 2005;45:15–27. doi: 10.1053/j.ajkd.2004.09.010.
    1. Newell SA, Bowman JA, Cockburn JD. Can compliance with nonpharmacologic treatments for cardiovascular disease be improved? Am J Prev Med. 2000;18:253–261. doi: 10.1016/S0749-3797(99)00157-9.
    1. Leventhal EA, Cameron L. Behavioral theories and the problem of compliance. Patient Educ Couns. 1987;10:117–138. doi: 10.1016/0738-3991(87)90093-0.
    1. Ammassari A, Trotta MP, Murri R, Castelli F, Narciso P, Noto P, Vecchiet J, D'Arminio Monforte A, Wu AW, Antinori A, AdICoNA Study Group Correlates and predictors of adherence to highly active antiretroviral therapy: overview of published literature. J Acquir Immune Defic Syndr. 2002;31:S123–S127.
    1. Bandura A. Self-efficacy: toward a unifying theory of behavior change. Psychol Rev. 1977;84:191–215. doi: 10.1037/0033-295X.84.2.191.
    1. Leventhal H, Falconer L, Diefenbach M, Leventhal EA. From compliance to social-self-regulation: Models of the compliance process. In: Blackwell B, editor. Treatment compliance and the therapeutic alliance. Amsterdam: Harwood Academic Publishers; 1997. pp. 17–33.
    1. Leventhal H, Leventhal EA, Contrada RJ. Self-regulation, health and behavior: A perceptual-cognitive approach. Psychol Health. 1998;13:717–733.
    1. Newell SA, Bowman JA, Cockburn JD. A critical review of interventions to increase compliance with medication-taking, obtaining medication refills, and appointment-keeping in the treatment of cardiovascular disease. Prev Med. 1999;29:535–548. doi: 10.1006/pmed.1999.0579.
    1. Pampallona S, Bollini P, Tibaldi G, Kupelnick B, Munizza C. Patient adherence in the treatment of depression. Br J Psychiatry. 2002;180:104–109. doi: 10.1192/bjp.180.2.104.
    1. Van der Wal MHL, Jaarsma T, Van Veldhuisen DJ. Non-compliance in patients with heart failure; how can we manage it? Eur J Heart Fail. 2005;7:5–17. doi: 10.1016/j.ejheart.2004.04.007.

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