Physician Effectiveness in Interventions to Improve Cardiovascular Medication Adherence: A Systematic Review
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Medications for the prevention and treatment of cardiovascular disease save lives but adherence is often inadequate. The optimal role for physicians in improving adherence remains unclear.
Using existing evidence, we set the goal of evaluating the physician’s role in improving medication adherence.
We conducted systematic searches of English-language peer-reviewed publications in MEDLINE and EMBASE from 1966 through 12/31/2008.
SUBJECTS AND INTERVENTIONS
We selected randomized controlled trials of interventions to improve adherence to medications used for preventing or treating cardiovascular disease or diabetes.
Articles were classified as either (1) physician “active”—a physician participated in designing or implementing the intervention; (2) physician “passive”—physicians treating intervention group patients received patient adherence information while physicians treating controls did not; or (3) physicians noninvolved. We also identified studies in which healthcare professionals helped deliver the intervention. We did a meta-analysis of the studies involving healthcare professionals to determine aggregate Cohen’s D effect sizes (ES).
We identified 6,550 articles; 168 were reviewed in full, 82 met inclusion criteria. The majority of all studies (88.9%) showed improved adherence. Physician noninvolved studies were more likely (35.0% of studies) to show a medium or large effect on adherence compared to physician-involved studies (31.3%). Among interventions requiring a healthcare professional, physician-noninvolved interventions were more effective (ES 0.47; 95% CI 0.38–0.56) than physician-involved interventions (ES 0.25; 95% CI 0.21–0.29; p < 0.001). Among physician-involved interventions, physician-passive interventions were marginally more effective (ES 0.29; 95% CI 0.22–0.36) than physician-active interventions (ES 0.23; 95% CI 0.17–0.28; p = 0.2).
Adherence interventions utilizing non-physician healthcare professionals are effective in improving cardiovascular medication adherence, but further study is needed to identify the optimal role for physicians.
KEY WORDSmedication adherence pharmaceutical care doctor–patient relationships preventive care systematic reviews
Acknowledgements and Conflicts of Interest Disclosure
This work was supported by a research grant from CVS Caremark. All data analysis and evaluation took place at Brigham and Women’s Hospital. CVS Caremark did not play a role in the design and conduct of the study, the collection, management, analysis, or interpretation of the data, the preparation, review or approval of the manuscript. Josh Liberman and Troy Brennan, both co-authors, are employees of CVS Caremark. Dr. Shrank is supported by a career development award from the National Heart, Lung and Blood Institute (HL-090505). Dr. Brookhart is supported by a career development award from the National Institute of Health (AG-027400). Dr. Cutrona has had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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