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The Effectiveness of Medication Adherence Interventions Among Patients With Coronary Artery Disease: A Meta-analysis
Jo-Ana D Chase1, Jennifer L Bogener, Todd M Ruppar
1Jo-Ana D. Chase, PhD, APRN-BC Assistant Professor, S343 School of Nursing, University of Missouri, Columbia. Jennifer L. Bogener, BSN Nursing Student, School of Nursing School of Health Professions, University of Missouri, Columbia. Todd M. Ruppar, PhD, RN Assistant Professor, S423 School of Nursing, University of Missouri, Columbia. Vicki S. Conn, PhD, RN, FAAN Potter-Brinton Professor and Associate Dean for Research, S317 School of Nursing University of Missouri Columbia.
Insights
Medication adherence interventions for coronary artery disease (CAD) patients show modest effectiveness. Nurse-led interventions, especially in inpatient settings, are most successful. Further research is needed for younger and diverse populations.
Area of Science:
- Cardiology
- Health Services Research
- Behavioral Medicine
Background:
- Medication nonadherence is prevalent in coronary artery disease (CAD) patients, leading to adverse health outcomes and increased healthcare costs.
- Effective secondary prevention strategies for CAD are crucial, yet adherence to prescribed medications remains a significant challenge.
Purpose of the Study:
- To evaluate the overall effectiveness of interventions aimed at improving medication adherence (MA) in adults with CAD.
- To identify sample, study design, and intervention characteristics that may moderate intervention effectiveness.
Main Methods:
- A meta-analysis was conducted on 2-group, treatment-versus-control studies of MA interventions in CAD patients.
- Data from 24 primary studies (18,839 participants) were synthesized using a random-effects model to calculate standardized mean difference effect sizes.
- Moderator analyses explored factors influencing intervention effectiveness.
Main Results:
- Medication adherence interventions demonstrated a modest overall effect size of 0.229 (P < .001).
- Interventions were most effective when delivered by nurses, initiated during inpatient stays, and involved informing providers about patient adherence.
- Interventions were more effective in older adults compared to younger adults.
Conclusions:
- Interventions to improve MA in CAD patients yield modest but significant benefits.
- Nurses play a vital role in enhancing medication adherence among CAD patients.
- Future research should focus on nurse-delivered interventions in diverse settings and populations, particularly younger and more racially diverse groups.
Background:
Despite the known benefits of medication therapy for secondary prevention of coronary artery disease (CAD), many patients do not adhere to prescribed medication regimens. Medication nonadherence is associated with poor health outcomes and higher healthcare cost.
Objective:
The purpose of this meta-analysis was to determine the overall effectiveness of interventions designed to improve medication adherence (MA) among adults with CAD. In addition, sample, study design, and intervention characteristics were explored as potential moderators to intervention effectiveness.
Methods:
Comprehensive search strategies helped in facilitating the identification of 2-group, treatment-versus-control-design studies testing MA interventions among patients with CAD. Data were independently extracted by 2 trained research specialists. Standardized mean difference effect sizes were calculated for eligible primary studies, adjusted for bias, and then synthesized under a random-effects model. Homogeneity of variance was explored using a conventional heterogeneity statistic. Exploratory moderator analyses were conducted using meta-analytic analogs for analysis of variance and regression for dichotomous and continuous moderators, respectively.
Results:
Twenty-four primary studies were included in this meta-analysis. The overall effect size of MA interventions, calculated from 18,839 participants, was 0.229 (P < .001). The most effective interventions used nurses as interventionists, initiated interventions in the inpatient setting, and informed providers of patients' MA behaviors. Medication adherence interventions tested among older patients were more effective than those among younger patients. The interventions were equally effective regardless of number of intervention sessions, targeting MA behavior alone or with other behaviors, and the use of written instructions only.
Conclusions:
Interventions to increase MA among patients with CAD were modestly effective. Nurses can be instrumental in improving MA among these patients. Future research is needed to investigate nurse-delivered MA interventions across varied clinical settings. In addition, more research testing MA interventions among younger populations and more racially diverse groups is needed.
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