Skip to main content
Log in

Nurse-led interventions to enhance adherence to chronic medication: systematic review and meta-analysis of randomised controlled trials

  • Review Article
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript



Non-adherence to chronic medication remains an important problem with vast consequences and without solutions to date. Nurses are well positioned to provide adherence care, yet currently represent an underutilised force in improving adherence and outcomes. This review aims to synthesise the effect of nurse-led interventions on adherence to chronic medication.


Using Review Manager software, a meta-analysis was conducted. The search term medication adherence was combined with random* and nurse in PubMed and ISI Web of Knowledge. Retrieved articles’ reference lists were hand searched. Included were randomised controlled trials on nurse-led interventions, aiming to improve chronic medication adherence. Articles were to be in English and published from 2006 to 2011. Quality was assessed using an adapted version of the CONSORT tool.


Ten studies met the selection criteria, seven of which were on HIV-positive patients. Their quality was acceptable to high. Counselling was the intervention most frequently assessed, mostly given face-to-face, but also in groups and via electronic messages. All interventions enhanced adherence. Of the five studies reporting adherence as mean percentage of adherence, pooled mean differences were +5.39 (1.70–9.07) (short term) and +9.49 (4.68–14.30) (long term), favouring the intervention groups. Of the studies reporting adherence dichotomously, odd's ratios were 1.55 (1.04–2.29) (short term) and 1.87 (1.35–2.61) (long term). The longer counselling was effectuated, the better the results.


Counselling appears to be an effective approach that nurses can use to supplement other methods, building a multifaceted strategy to enhance adherence. Tackling non-adherence seems to demand continuous efforts and follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Simoni JM, Chen WT, Huh D, Fredriksen-Goldsen KI, Pearson C, Zhao HX, Shiu CS, Wang X, Zhang FJ (2011) A preliminary randomized controlled trial of a nurse-delivered medication adherence intervention among HIV-positive outpatients initiating antiretroviral therapy in Beijing, china. AIDS Behav 15(5):919–929. doi:10.1007/s10461-010-9828-3

    Article  PubMed  Google Scholar 

  2. de Bruin M, Hospers HJ, van Breukelen GJP, Kok G, Koevoets WM, Prins JM (2010) Electronic monitoring-based counseling to enhance adherence among HIV-infected patients: a randomized controlled trial. Health Psychol 29(4):421–428. doi:10.1037/a0020335

    Article  PubMed  Google Scholar 

  3. DiIorio C, McCarty F, Resnicow K, Holstad MM, Soet J, Yeager K, Sharma SM, Morisky DE, Lundberg B (2008) Using motivational interviewing to promote adherence to antiretroviral medications: a randomized controlled study. Aids Care-Psychol Socio-Med Asp Aids-Hiv 20(3):273–283. doi:10.1080/09540120701593489

    Article  CAS  Google Scholar 

  4. Koenig LJ, Pals SL, Bush T, Palmore MP, Stratford D, Ellerbrock TV (2008) Randomized controlled trial of an intervention to prevent adherence failure among HIV-Infected patients initiating Antiretroviral therapy. Health Psychol 27(2):159–169. doi:10.1037/0278-6133.27.2.159

    Article  PubMed  Google Scholar 

  5. Holzemer WL, Bakken S, Portillo CJ, Grimes R, Welch J, Wantland D, Mullan JT (2006) Testing a nurse-tailored HIV medication adherence intervention. Nurs Res 55(3):189–197. doi:10.1097/00006199-200605000-00005

    Article  PubMed  Google Scholar 

  6. Williams AB, Fennie KP, Bova CA, Burgess JD, Danvers KA, Dieckhaus KD (2006) Home visits to improve adherence to highly active antiretroviral therapy: a randomized controlled trial. J Acquir Immune Defic Syndr. 42(3):314–321. doi:10.1097/01.qai.0000221681.60187.88

    Article  PubMed  Google Scholar 

  7. Simon GE, Ralston JD, Savarino J, Pabiniak C, Wentzel C, Operskalski BH (2011) Randomized trial of depression follow-up care by online messaging. J Gen Intern Med 26(7):698–704. doi:10.1007/s11606-011-1679-8

    Article  PubMed  Google Scholar 

  8. Guirado EA, Ribera EP, Huergo VP, Borras JM, Grp A (2011) Knowledge and adherence to antihypertensive therapy in primary care: results of a randomized trial. Gac Sanit 25(1):62–67. doi:10.1016/j.gaceta.2010.09.015

    Article  Google Scholar 

  9. Homer D, Nightingale P, Jobanputra P (2009) Providing patients with information about disease-modifying anti-rheumatic drugs: Individually or in groups? A pilot randomized controlled trial comparing adherence and satisfaction. Musculoskelet Care 7(2):78–92. doi:10.1002/msc.141

    Article  Google Scholar 

  10. Sarna A, Luchters S, Geibel S, Chersich MF, Munyao P, Kaai S, Mandaliya KN, Shikely KS, Temmerman M, Rutenberg N (2008) Short- and long-term efficacy of modified directly observed antiretroviral treatment in Mombasa, Kenya: a randomized trial. J Acquir Immune Defic Syndr. 48(5):611–619

    Article  PubMed  CAS  Google Scholar 

  11. World Health Organisation (2005) Preventing chronic diseases: a vital investment: WHO global report. Geneva, Switzerland

    Google Scholar 

  12. Vrijens B, De Geest S, Hughes DA, Kardas P, Demonceau J, Ruppar T, Dobbels F, Fargher E, Morrison V, Lewek P, Matyjaszczyk M, Mshelia C, Clyne W, Aronson JK, Urquhart J, team ABC (2011) A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 73(5):691-705 doi:10.1111/j.1365-2125.2011.04167.x

  13. World Health Organisation (2003) Adherence to long-term therapies: evidence for action. Geneva, Switzerland

    Google Scholar 

  14. Simpson SH, Eurich DT, Majumdar SR, Padwal RS, Tsuyuki RT, Varney J, Johnson JA (2006) A meta-analysis of the association between adherence to drug therapy and mortality. Br Med J 333(7557):15–18. doi:10.1136/bmj.38875.675486.55

    Article  Google Scholar 

  15. Hughes DA (2002) Economic impact of poor compliance with pharmaceuticals. Expert Rev Pharmacoecon Outcomes Res. 2(4):327–335. doi:10.1586/14737167.2.4.327

    Article  PubMed  Google Scholar 

  16. Nolte E, McKee M (2008) Caring for people with chronic conditions: a health system perspective. Open University Press, Berkshire

    Google Scholar 

  17. Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X (2008) Interventions for enhancing medication adherence. Cochrane Database Syst Rev (2). doi:10.1002/14651858.CD000011.pub3

  18. De Geest S (2009) Care for the chronically Ill: a challenge also for nursing! J Nurs Scholarsh 41(3):229–230

    Article  PubMed  Google Scholar 

  19. Van Camp YP, Huybrechts SA, Van Rompaey B, Elseviers MM (2012) Nurse-led education and counselling to enhance adherence to phosphate binders. J Clin Nurs 21(9–10):1304–1313. doi:10.1111/j.1365-2702.2011.03967.x

    Article  PubMed  Google Scholar 

  20. Connelly LM (2008) Pilot studies. Medsurg Nurs Off J Acad Med-Surg Nurses 17(6):411–412

    Google Scholar 

  21. Osterberg L, Blaschke T (2005) Drug therapy - Adherence to medication. N Engl J Med 353(5):487–497. doi:10.1056/NEJMra050100

    Article  PubMed  CAS  Google Scholar 

  22. Needleman I, Worthington H, Moher D, Schulz K, Altman DG (2008) Improving the completeness and transparency of reports of randomized trials in oral health: The CONSORT Statement. Am J Dent 21(1):7–12

    PubMed  Google Scholar 

  23. Higgins JPT GS (2011) Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0

  24. Blaschke TF, Osterberg L, Vrijens B, Urquhart J (2012) Adherence to Medications: Insights Arising from Studies on the Unreliable Link Between Prescribed and Actual Drug Dosing Histories. In: Insel PA, Amara SG, Blaschke TF (eds) Annu Rev Pharmacol Toxicol 52: Annual Reviews, Palo Alto, pp 275-+. doi:10.1146/annurev-pharmtox-011711-113247

  25. Williams A, Manias E, Walker R (2008) Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. J Adv Nurs 63(2):132–143. doi:10.1111/j.1365-2648.2008.04656.x

    Article  PubMed  Google Scholar 

  26. Kripalani S, Yao XM, Haynes RB (2007) Interventions to enhance medication adherence in chronic medical conditions - A systematic review. Arch Intern Med 167(6):540–550. doi:10.1001/archinte.167.6.540

    Article  PubMed  Google Scholar 

  27. Conn VS, Hafdahl AR, Cooper PS, Ruppar TM, Mehr DR, Russell CL (2009) Interventions to improve medication adherence among older adults: meta-analysis of adherence outcomes among randomized controlled trials. Gerontologist 49(4):447–462. doi:10.1093/geront/gnp037

    Article  PubMed  Google Scholar 

  28. Russell CL, Ruppar TM, Matteson M (2011) Improving medication adherence: moving from intention and motivation to a personal systems approach. Nurs Clin North Am 46(3):271-+. doi:10.1016/j.cnur.2011.05.004

    Article  PubMed  Google Scholar 

  29. Sereika SM, Erlen JA, Tamres LK, Kang HJ (2012) Is self-efficacy a mediator of the effect of behavioral interventions on medication adherence in persons with HIV? Ann Behav Med 43:S232

    Google Scholar 

  30. Hill S, Kavookjian J (2012) Motivational interviewing as a behavioral intervention to increase HAART adherence in patients who are HIV-positive: a systematic review of the literature. Aids Care-Psychol Socio-Med Asp Aids-Hiv 24(5):583–592. doi:10.1080/09540121.2011.630354

    Article  Google Scholar 

  31. Horvath T, Azman H, Kennedy GE, Rutherford GW (2012) Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection. Cochrane Database Syst Rev (3). doi:10.1002/14651858.cd009756

  32. Bain-Brickley D, Butler LM, Kennedy GE, Rutherford GW (2011) Interventions to improve adherence to antiretroviral therapy in children with HIV infection. Cochrane Database Syst Rev (12). doi:10.1002/14651858.cd009513

  33. Knobel H, Guelar A, Carmona A, Espona M, Gonzalez A, Lopez-Colomes JL, Saballs P, Gimeno JL, Diez A (2001) Virologic outcome and predictors of virologic failure of highly active antiretroviral therapy containing protease inhibitors. Aids Patient Care STDS 15(4):193–199. doi:10.1089/10872910151133729

    Article  PubMed  CAS  Google Scholar 

  34. Gross R, Yip B, Lo Re V, Wood E, Alexander CS, Harrigan PR, Bangsberg DR, Montaner JSG, Hogg RS (2006) A simple, dynamic measure of antiretroviral therapy adherence predicts failure to maintain HIV-1 suppression. J Infect Dis 194(8):1108–1114. doi:10.1086/507680

    Article  PubMed  Google Scholar 

  35. Ailinger RL, Black PL, Lima-Garcia N (2008) Use of electronic monitoring in clinical nursing research. Clin Nurs Res 17(2):89–97. doi:10.1177/1054773808316941

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare they have no conflict of interest.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Yoleen P. Van Camp.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Van Camp, Y.P., Van Rompaey, B. & Elseviers, M.M. Nurse-led interventions to enhance adherence to chronic medication: systematic review and meta-analysis of randomised controlled trials. Eur J Clin Pharmacol 69, 761–770 (2013).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: