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McDonald HP, Garg AX, Haynes RB. Interventions to Enhance Patient Adherence to Medication Prescriptions: Scientific Review. JAMA. 2002;288(22):2868–2879. doi:10.1001/jama.288.22.2868
Author Affiliations: Health Research Methodology Program, McMaster University School of Graduate Studies (Ms McDonald and Dr Garg), and Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University Faculty of Health Sciences (Dr Haynes), Hamilton, Ontario.
Scientific Review and Clinical Applications Section
Editor: Wendy Levinson, MD, Contributing Editor.
Context Low adherence with prescribed treatments is ubiquitous and undermines
Objective To systematically review published randomized controlled trials (RCTs)
of interventions to assist patients' adherence to prescribed medications.
Data Sources A search of MEDLINE, CINAHL, PSYCHLIT, SOCIOFILE, IPA, EMBASE, The Cochrane
Library databases, and bibliographies was performed for records from 1967
through August 2001 to identify relevant articles of all RCTs of interventions
intended to improve adherence to self-administered medications.
Study Selection and Data Extraction Studies were included if they reported an unconfounded RCT of an intervention
to improve adherence with prescribed medications for a medical or psychiatric
disorder; both adherence and treatment outcome were measured; follow-up of
at least 80% of each study group was reported; and the duration of follow-up
for studies with positive initial findings was at least 6 months. Information
on study design features, interventions, controls, and findings (adherence
rates and patient outcomes) were extracted for each article.
Data Synthesis Studies were too disparate to warrant meta-analysis. Forty-nine percent
of the interventions tested (19 of 39 in 33 studies) were associated with
statistically significant increases in medication adherence and only 17 reported
statistically significant improvements in treatment outcomes. Almost all the
interventions that were effective for long-term care were complex, including
combinations of more convenient care, information, counseling, reminders,
self-monitoring, reinforcement, family therapy, and other forms of additional
supervision or attention. Even the most effective interventions had modest
Conclusions Current methods of improving medication adherence for chronic health
problems are mostly complex, labor-intensive, and not predictably effective.
The full benefits of medications cannot be realized at currently achievable
levels of adherence; therefore, more studies of innovative approaches to assist
patients to follow prescriptions for medications are needed.
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