A systematic overview of systematic reviews evaluating medication adherence interventions

Area of Science:

• Pharmacoeconomics
• Health Services Research
• Evidence-Based Medicine

Background:

• Medication nonadherence is a significant challenge in managing chronic diseases.
• Systematic reviews (SRs) offer a valuable method for synthesizing evidence on interventions.

Purpose of the Study:

• To systematically summarize evidence from multiple SRs on interventions for medication nonadherence.
• To identify effective interventions and analyze effectiveness based on intervention, patient, and study characteristics.

Main Methods:

• Searched MEDLINE, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects (January 2004-February 2017).
• Included English-language SRs on adult patients with diabetes, heart conditions, hypertension, stroke, or cognitive impairment.
• Assessed SR quality using the Assessment of Multiple Systematic Reviews (AMSTAR) tool and evidence quality using Grades of Recommendation, Assessment, Development and Evaluation (GRADE).

Main Results:

• 25 SRs met inclusion criteria, assessing adherence as a primary outcome.
• Effective interventions included dose simplification, patient education, electronic reminders, and reduced patient cost sharing or incentives.
• Evidence quality supporting SR conclusions was low or very low for 45 out of 50 conclusions.

Conclusions:

• Despite numerous primary studies, the evidence base for medication adherence interventions is largely of low quality.
• Health systems should prioritize interventions like dose simplification, education, reminders, and financial incentives due to consistent effectiveness.
• Further high-quality research is needed to strengthen the evidence base for medication adherence strategies.