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Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis

  • Vicki S. ConnEmail author
  • Todd M. Ruppar
  • Jo-Ana D. Chase
  • Maithe Enriquez
  • Pamela S. Cooper
Prevention of Hypertension: Public Health Challenges (P Muntner, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Prevention of Hypertension: Public Health Challenges

Abstract

This systematic review applied meta-analytic procedures to synthesize medication adherence interventions that focus on adults with hypertension. Comprehensive searching located trials with medication adherence behavior outcomes. Study sample, design, intervention characteristics, and outcomes were coded. Random-effects models were used in calculating standardized mean difference effect sizes. Moderator analyses were conducted using meta-analytic analogues of ANOVA and regression to explore associations between effect sizes and sample, design, and intervention characteristics. Effect sizes were calculated for 112 eligible treatment-vs.-control group outcome comparisons of 34,272 subjects. The overall standardized mean difference effect size between treatment and control subjects was 0.300. Exploratory moderator analyses revealed interventions were most effective among female, older, and moderate- or high-income participants. The most promising intervention components were those linking adherence behavior with habits, giving adherence feedback to patients, self-monitoring of blood pressure, using pill boxes and other special packaging, and motivational interviewing. The most effective interventions employed multiple components and were delivered over many days. Future research should strive for minimizing risks of bias common in this literature, especially avoiding self-report adherence measures.

Keywords

Hypertension Medication adherence Patient compliance Meta-analysis 

Notes

Acknowledgments

The project was supported by Award Numbers 13GRNT16550001 (Conn-principal investigator) from the American Heart Association and R01NR011990 (Conn-principal investigator) from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Heart Association or the National Institutes of Health.

Compliance with Ethical Standards

Conflict of Interest

Drs. Conn and Cooper report grants from American Heart Association and the National Institutes of Health. Drs. Chase, Enriquez, and Ruppar have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Vicki S. Conn
    • 1
    Email author
  • Todd M. Ruppar
    • 2
  • Jo-Ana D. Chase
    • 3
  • Maithe Enriquez
    • 4
  • Pamela S. Cooper
    • 5
  1. 1.School of NursingUniversity of MissouriColumbiaUSA
  2. 2.School of NursingUniversity of MissouriColumbiaUSA
  3. 3.School of NursingUniversity of MissouriColumbiaUSA
  4. 4.School of NursingUniversity of MissouriColumbiaUSA
  5. 5.School of NursingUniversity of MissouriColumbiaUSA

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