Background Non-adherence in patients with multiple chronic conditions (PMCC) is associated with poor disease control, reduced quality of life and increased risk of morbidity and mortality
Purpose To assess the available scientific evidence regarding the efficacy of interventions aimed to improve medicines adherence that are applicable to PMCC.
Material and methods Overview of systematic reviews (SRs). The following databases were consulted (September 2013): PubMed, EMBASE, the Cochrane Library, CRD and WoS to identify SRs of clinical trials focused on PMCC, or otherwise, patients with chronic diseases common in the PMCC, or polypharmacy. SRs that compared the efficacy of any intervention aiming to improve compliance with medicines with clinical practice or other interventions were included. For every SR and type of intervention (behavioural, educational and combined) the percentage of clinical trials in which adherence improved was estimated. Rates were combined between SRs by means and ranges. Meta-analysis could not be conducted because of the heterogeneity of the data. This analysis was also applied to the components from those interventions described in ≥1 SR.
Results 566 articles were retrieved of which 9 SRs were included. None was specifically focused on PMCC but considered patients with chronic diseases common in PMCC, patients with more than one chronic disease and polypharmacy.
Seven, three and six SRs reported behavioural, educational and combined interventions, respectively. The mean efficacy rates were 49% [0–100], 51% [0–100%] and 53% [44–75]. The components from those interventions which reported higher efficacy were: counselling about the patients’ target disease, the importance of treatment and compliance with treatment (5 SR, 79% [47–100]), reminders (4 SR, 70% [50–100]), simplified dosing (3 SR, 90% [75–100]) and special pill packaging (2 SR, 83% [66–100]).
Conclusion There is a large heterogeneity in the efficacy of interventions aimed to improve medicines adherence that are applicable to PMCC. Nevertheless, they seem to have a modest impact on adherence. Some components of the interventions appear to have greater efficacy.
References and/or Acknowledgements
Arch Intern Med 2007;167:540–50
References and/or AcknowledgementsNo conflict of interest.
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