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Systematic Review of Clinical Practice Guidelines for the Improvement of Medication Adherence

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Abstract

Background

Poor adherence to medications is a significant problem that leads to increased morbidity, mortality, and health care costs. Recommended approaches to address medication adherence vary, and existing practice guidelines are unclear.

Purpose

This review evaluated clinical practice guidelines designed to help health care providers address patients’ medication adherence.

Method

Multiple search methods were used to identify national or international guidelines addressing medication adherence. We included guidelines published in English, as well as guidelines with an English-language summary or translation.

Results

We identified 23 guidelines of varying detail and quality. Recommendations were categorized as assessment strategies (n = 20 guidelines); educational strategies (n = 18); behavioral strategies (n = 17); therapeutic relationship, communication, and provider factors (n = 19); and addressing outside influences/co-morbidities (n = 10).

Conclusion

Future guidelines should be more clearly guided by research findings and comparative effectiveness methods. When implemented, guidelines will facilitate health care providers and health systems in supporting optimal adherence and improved health outcomes.

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References

  1. Vrijens B, Geest SD, Hughes D, Kardas P, Demonceau J, Ruppar T, et al. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012;73(5):691–705.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Sabate E. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.

    Google Scholar 

  3. Dunbar-Jacob J, Erlen JA, Schlenk EA, Ryan CM, Sereika SM, Doswell WM. Adherence in chronic disease. Annu Rev Nurs Res. 2000;18:48–90.

    CAS  PubMed  Google Scholar 

  4. DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care. 2002;40(9):794–811.

    Article  PubMed  Google Scholar 

  5. Blaschke TF, Osterberg L, Vrijens B, Urquhart J. Adherence to medications: insights arising from studies on the unreliable link between prescribed and actual drug dosing histories. Annu Rev Pharmacol Toxicol. 2012;52:275–301.

    Article  CAS  PubMed  Google Scholar 

  6. Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005;43(6):521–30.

    Article  PubMed  Google Scholar 

  7. Vlasnik JJ, Aliotta SL, DeLor B. Medication adherence: factors influencing compliance with prescribed medication plans. Case Manager. 2005;16(2):47–51.

    Article  PubMed  Google Scholar 

  8. Institute of Medicine. Clinical practice guidelines we can trust. Washington: National Academy of Sciences; 2011.

    Google Scholar 

  9. Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. The Global Rating Scale complements the AGREE II in advancing the quality of practice guidelines. J Clin Epidemiol. 2012;65(5):526–34.

    Article  PubMed  Google Scholar 

  10. Loudon K, Santesso N, Callaghan M, Thornton J, Harbour J, Graham K, et al. Patient and public attitudes to and awareness of clinical practice guidelines: a systematic review with thematic and narrative syntheses. BMC Health Serv Res. 2014;14:321.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.

    Article  PubMed  Google Scholar 

  12. Abraham C, Michie S. A taxonomy of behavior change techniques used in interventions. Health Psychol. 2008;27(3):379–87.

    Article  PubMed  Google Scholar 

  13. Cane J, Richardson M, Johnston M, Ladha R, Michie S. From lists of behaviour change techniques (BCTs) to structured hierarchies: comparison of two methods of developing a hierarchy of BCTs. Br J Health Psychol. 2014;20(1):130–50.

    Article  PubMed  Google Scholar 

  14. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81–95.

    Article  PubMed  Google Scholar 

  15. Aliotta SL, Vlasnik JJ, Delor B. Enhancing adherence to long-term medical therapy: a new approach to assessing and treating patients. Adv Ther. 2004;21(4):214–31.

    Article  PubMed  Google Scholar 

  16. Benagiano G, Serfaty D, Adams Hillard PJ, Potter L, Demeyer F, Thorneycroft IH, et al. A consensus statement: enhancing patient compliance and oral contraceptive efficacy. Br J Fam Plann. 1993;18(4):126–9.27.

    Google Scholar 

  17. Campbell NR, Kaczorowski J, Lewanczuk RZ, Feldman R, Poirier L, Kwong MM, et al. 2010 Canadian Hypertension Education Program (CHEP) recommendations: the scientific summary—an update of the 2010 theme and the science behind new CHEP recommendations. Can J Cardiol. 2010;26(5):236–40.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Hackam DG, Khan NA, Hemmelgarn BR, Rabkin SW, Touyz RM, Campbell NR, et al. The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2—therapy. Can J Cardiol. 2010;26(5):249–58.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Chockalingam A, Bacher M, Campbell N, Cutler H, Drover A, Feldman R, et al. Adherence to management of high blood pressure: recommendations of the Canadian Coalition for High Blood Pressure Prevention and Control. Can J Public Health. 1998;89(5):I5–11.

    CAS  PubMed  Google Scholar 

  20. Guilbert E, Black A, Dunn S, Senikas V, Berube J, Charbonneau L, et al. Missed hormonal contraceptives: new recommendations. J Obstet Gynaecol Can. 2008;30(11):1050–62. 63-77.

    PubMed  Google Scholar 

  21. Hill MN, Miller NH, DeGeest S. ASH position paper: adherence and persistence with taking medication to control high blood pressure. J Clin Hypertens (Greenwich). 2010;12(10):757–64.

    Article  Google Scholar 

  22. Miller NH, Hill M, Kottke T, Ockene IS. The multilevel compliance challenge: recommendations for a call to action. A statement for healthcare professionals. Circulation. 1997;95(4):1085–90.

    Article  CAS  PubMed  Google Scholar 

  23. Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2013;24(1):23–57.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Kasiske BL, Zeier MG, Chapman JR, Craig JC, Ekberg H, Garvey CA, et al. KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney Int. 2010;77(4):299–311.

    Article  PubMed  Google Scholar 

  25. Knobel H, Codina C, Miro JM, Carmona A, Garcia B, Antela A, et al. The recommendations of GESIDA/SEFH/PNS for improving adherence to antiretroviral treatment. AIDS Study Group of the Spanish Society of Hospital Pharmacy and the National Plan on AIDS of the Minister of Health and Consumers. Enferm Infecc Microbiol Clin. 2000;18(1):27–39.

    CAS  PubMed  Google Scholar 

  26. Machtinger EL, Bangsberg DR. Seven steps to better adherence: a practical approach to promoting adherence to antiretroviral therapy. AIDS Reader. 2007;17(1):43–51.

    PubMed  Google Scholar 

  27. Maia Jr H, Bossemeyer R, Espinosa-Larranaga F, Murillo A, Siseles N. Clinical guidelines for improving compliance with hormone therapy in Latin American women during the menopausal transition and thereafter. Maturitas. 2007;56(1):101–9.

    Article  PubMed  Google Scholar 

  28. National Asthma Council Australia. Asthma adherence: a guide for health professionals. National Asthma Council Australia; 2005.

  29. The North American Menopause Society. Achieving long-term continuance of menopausal ERT/HRT: consensus opinion of the North American Menopause Society. Menopause. 1998;5(2):69–76.

    Google Scholar 

  30. Nunes V, Neilson J, O’Flynn N, Calvert N, Kuntze S, Smithson H, et al. Clinical Guidelines and Evidence Review for Medicines Adherence: involving patients in decisions about prescribed medicines and supporting adherence. London: National Collaborating Centre for Primary Care and Royal College of General Practitioners; 2009.

    Google Scholar 

  31. Ockene IS, Hayman LL, Pasternak RC, Schron E, Dunbar-Jacob J. Task force #4–adherence issues and behavior changes: achieving a long-term solution. 33rd Bethesda Conference. J Am Coll Cardiol. 2002;40(4):630–40.

    Article  PubMed  Google Scholar 

  32. Panel on Clinical Practices for Treatment of HIV Infection. Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents (February 5, 2001). HIV Clin Trials. 2001;2(3):227–76.

    Article  Google Scholar 

  33. Poppa A, Davidson O, Deutsch J, Godfrey D, Fisher M, Head S, et al. British HIV Association (BHIVA)/British Association for Sexual Health and HIV (BASHH) guidelines on provision of adherence support to individuals receiving antiretroviral therapy (2003). HIV Med. 2004;5 Suppl 2:46–60.

    Article  PubMed  Google Scholar 

  34. Royal Pharmaceutical Society. Medicines optimisation: helping patients to make the most of medicines. London: Royal Pharmaceutical Society. 2013 May.

  35. Thompson MA, Mugavero MJ, Amico KR, Cargill VA, Chang LW, Gross R et al. Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care panel. Ann Intern Med. 2012;156(11):817-33, W-284, W-5, W-6, W-7, W-8, W-9, W-90, W-91, W-92, W-93, W-94.

  36. Trivedi MH, Lin EH, Katon WJ. Consensus recommendations for improving adherence, self-management, and outcomes in patients with depression. CNS Spectr. 2007;12(8 Suppl 13):1–27.

    PubMed  Google Scholar 

  37. Velligan DI, Weiden PJ, Sajatovic M, Scott J, Carpenter D, Ross R, et al. The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness. J Clin Psychiatry. 2009;70 Suppl 4:1–46.

    PubMed  Google Scholar 

  38. Yamout BI, Dahdaleh M, Al Jumah MA, Al-Shammri S, Al Sharoqi I, Al-Tahan AR, et al. Adherence to disease-modifying drugs in patients with multiple sclerosis: a consensus statement from the Middle East MS Advisory Group. Int J Neurosci. 2010;120(4):273–9.

    Article  PubMed  Google Scholar 

  39. Royal pharmaceutical society issues medicines optimisation guidance. Drug Ther Bull. 2013;51(7):76.

  40. Zeber JE, Manias E, Williams AF, Hutchins D, Udezi WA, Roberts CS, et al. A systematic literature review of psychosocial and behavioral factors associated with initial medication adherence: a report of the ISPOR medication adherence & persistence special interest group. Value Health. 2013;16(5):891–900.

    Article  PubMed  Google Scholar 

  41. Kardas P, Lewek P, Matyjaszczyk M. Determinants of patient adherence: a review of systematic reviews. Front Pharmacol. 2013;4:91.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Gellad WF, Grenard JL, Marcum ZA. A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity. Am J Geriatr Pharmacother. 2011;9(1):11–23.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Ruppar TM, Dobbels F, De Geest S. Medication beliefs and antihypertensive adherence among older adults: a pilot study. Geriatr Nurs. 2012;33(2):89–95.

    Article  PubMed  Google Scholar 

  44. Conn VS, Hafdahl AR, Cooper PS, Ruppar TM, Mehr DR, Russell CL. Interventions to improve medication adherence among older adults: meta-analysis of adherence outcomes among randomized controlled trials. Gerontologist. 2009;49(4):447–62.

    Article  PubMed  Google Scholar 

  45. Demonceau J, Ruppar T, Kristanto P, Hughes DA, Fargher E, Kardas P, et al. Identification and assessment of adherence-enhancing interventions in studies assessing medication adherence through electronically compiled drug dosing histories: a systematic literature review and meta-analysis. Drugs. 2013;73(6):545–62.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  46. Haynes BR, Ackloo E, Sahota N, McDonald PH, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2010;6:6.

    Google Scholar 

  47. De Geest S, Ruppar T, Berben L, Schonfeld S, Hill MN. Medication non-adherence as a critical factor in the management of presumed resistant hypertension: a narrative review. EuroIntervention. 2014;9(9):1102–9.

    PubMed  Google Scholar 

  48. Ruppar TM, Delgado JM, Temple J. Medication adherence interventions for heart failure patients: a meta-analysis. Eur J Cardiovasc Nurs. 2015. doi:10.1177/1474515115571213.

    Google Scholar 

  49. Conn VS, Ruppar TM, Enriquez M, Cooper PS, Chan KC. Healthcare provider targeted interventions to improve medication adherence: systematic review and meta-analysis. Int J Clin Pract. 2015. doi:10.1111/ijcp.12632.

  50. Berben L, Dobbels F, Engberg S, Hill MN, De Geest S. An ecological perspective on medication adherence. West J Nurs Res. 2012;34(5):635–53.

    Article  PubMed  Google Scholar 

  51. Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826–34.

    Article  PubMed  Google Scholar 

  52. Vanbuskirk KA, Wetherell JL. Motivational interviewing with primary care populations: a systematic review and meta-analysis. J Behav Med. 2014;37(4):768–80.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Lundahl B, Moleni T, Burke BL, Butters R, Tollefson D, Butler C, et al. Motivational interviewing in medical care settings: a systematic review and meta-analysis of randomized controlled trials. Patient Educ Couns. 2013;93(2):157–68.

    Article  PubMed  Google Scholar 

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Correspondence to Todd M. Ruppar.

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Ruppar, T.M., Dobbels, F., Lewek, P. et al. Systematic Review of Clinical Practice Guidelines for the Improvement of Medication Adherence. Int.J. Behav. Med. 22, 699–708 (2015). https://doi.org/10.1007/s12529-015-9479-x

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