Significant Improvement In Medication Adherence Research Articles

Educational programmes for improving medication adherence among older adults with coronary artery disease: a systematic review and meta-analysis

Abstract Background Coronary artery disease (CAD) is the leading cause of death worldwide. Adhering to CAD medications is the priority of its treatment. However, medication adherence is suboptimal among older adults with CAD. Educational programmes are widely used and recommended in improving medication adherence among older adults with CAD. However, the evidence about the effects of educational programmes on medication adherence among older adults with CAD is limited. Aim To evaluate the best available research evidence on the effects of educational programmes designed for improving medication adherence among older adults with CAD. Methods 12 English databases and five Chinese databases were searched from inception to January 2024. Randomised controlled trials or quasi-experimental studies examining the effects of educational programmes for improving medication adherence among older adults with CAD were included. The educational programmes included a set of planned activities aiming at improving the knowledge, attitudes, and skills of medication adherence. The outcome of medication adherence was measured by either objective or subjective methods. The quality of the included studies was assessed by the Cochrane Risk of Bias Tool v2 or the Risk of Bias In Non-randomised Studies of Interventions tool. Meta-analysis was conducted using random-effect models as appropriate. Narrative synthesis was conducted if the results of the included studies were not appropriate or possible for meta-analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Approach was used to assess the certainty of evidence. Results 5,607 records were retrieved and 5,599 records were excluded. Seven studies including six randomised controlled trials and one quasi-experimental study were included. Two studies were rated as low risk of bias. Five studies were rated as some concerns or moderate risk of bias due to inadequate information on blinding, allocation concealment, and the analysis of data according to the intention-to-treat principle. The results showed that the educational programmes were associated with significant improvements in medication adherence at immediately post-intervention (Standardised mean difference (SMD): 1.61, 95% CI: 0.03 to 3.19, P=0.05, Low quality of evidence), and at one to six months post-intervention (SMD: 1.13, 95% CI: 0.33 to 1.94, P=0.006, Moderate quality of evidence). Narrative synthesis found that the educational programmes potentially improved medication adherence over six months post-intervention. Conclusions The results show that the educational programmes could improve medication adherence among older adults with CAD. Designing the educational programmes with theoretical frameworks would be helpful to address the complex health needs of the older adults with CAD. More rigorous evaluation of the effectiveness of the programmes on long-term medication adherence of the older adults is warranted.Figure 1.Immediate post-interventionFigure 2.Medium-term post-intervention

Impact of Interventions on Medication Adherence in Patients With Coexisting Diabetes and Hypertension.

The coexistence of diabetes and hypertension is prevalent due to shared risk factors. Pharmacological treatment has been reported to be effective in managing both conditions. However, treatment effectiveness depends on the extent to which a patient adheres to their treatment. Poor adherence to long-term treatment for chronic diseases is a growing global problem of significant magnitude. Several interventions have been developed to help improve medication adherence in patients with coexisting diabetes and hypertension. This review aimed to determine the characteristics of these interventions and their impact on medication adherence. A systematic review of the literature was conducted using the PRISMA guidelines and registered in the PROSPERO International Registry of Systematic Reviews. Studies were searched in the databases CINAHL, Embase and Medline to identify relevant articles published during 2012-2023. The search concepts included 'medication adherence', 'hypertension', 'diabetes' and 'intervention'. Studies were included if they were in English and evaluated the impact of an intervention aimed at promoting adherence to medications for both diabetes and hypertension. Seven studies met the inclusion criteria, with five demonstrating a statistically significant improvement in medication adherence. Of the five studies that improved medication adherence, four were multifaceted and one was a single-component intervention. All successful interventions addressed at least two factors influencing non-adherence. Patient education was the foundation of most of the successful interventions, supported by other strategies, such as follow-ups and reminders. Multifaceted interventions that also included patient education had a positive impact on medication adherence in patients with coexisting diabetes and hypertension. Improving adherence in patients with coexisting diabetes and hypertension requires a multipronged approach that considers the range of factors impacting medication-taking. This systematic review provides comprehensive insights into the benefits of patient-centred approaches in intervention development and strengthening. Such patient involvement ensures that medication adherence interventions are more relevant, acceptable and effective, ultimately leading to better health outcomes and more meaningful patient engagement in healthcare research.

Impact of Pharmacist-led Interventions on Medication Adherence and Inhalation Technique in Adult Patients with COPD and Asthma

Introduction: Inhalation technique and medication adherence are essential prerequisites for achieving optimal therapeutic effects in patients with chronic obstructive pulmonary disease (COPD) and asthma. Although there are various effective treatments for respiratory disorders, disease control in these patients is still sub-optimal because of incorrect inhalation techniques and poor medication adherence. Pharmacist-led interventions have demonstrated a positive impact on improving inhalation technique, better medication adherence, and thus subsequently improving the quality of life of patients. Methods: Search engines such as PubMed, Google Scholar, and Science Direct were used to identify the relevant information using keywords: Chronic Obstructive Pulmonary Disease, Asthma, Pharmaceutical care, Pharmacist Intervention, Medication Adherence and Inhalation Technique. The relevant articles that were published between 2005 to 2021 were included and reviewed for the Pharmacist-led interventions to improve medication adherence, inhalation technique, and quality of life of patients with COPD and asthma. Results: Of the 300 articles screened, a total of 14 articles met the inclusion criteria and were included for review. Pharmacist-led interventions help to improve the medication adherence, inhalation technique, and quality of life of patients with COPD and asthma. Similarly, the articles mentioned in this review found that the interventions provided by the pharmacist to COPD and asthma patients were cost-effective in terms of reducing hospitalization rates and severe exacerbation rates. Conclusion: Our review concluded that the pharmacists’ interventions have a significant improvement in medication adherence and inhalation techniques with the enhancement of therapeutic effects in adult patients with COPD and asthma.

Interventions to improve medication adherence in adults with mental-physical multimorbidity in primary care: a systematic review.

Medication non-adherence is a notable contributor to healthcare inefficiency, resulting in poor medication management, impaired patient outcomes, and ineffective symptom control. To summarise interventions targeting medication adherence for adults with mental-physical multimorbidity in primary healthcare settings. A systematic review of the literature - published in any language and with any country of origin - was conducted. MEDLINE, EMBASE, PsycInfo, Web of Science, Cochrane Library, and the Cumulated Index to Nursing and Allied Health Literature - more commonly known as CINAHL - were searched for relevant studies. Data were extracted and synthesised using narrative synthesis. The Effective Practice and Organisation of Care (EPOC) taxonomy was used to classify intervention types. Risk of bias was assessed using the National Heart, Lung, and Blood Institute's quality assessment tool for controlled intervention studies. Eleven studies, representing 2279 patients, were included. All interventions examined were classified into one EPOC domain, namely 'delivery arrangements'. All included studies examined patients who had a physical condition and depression. Seven studies examining interventions focused on coordination of care and management of care processes reported statistically significant improvements in medication adherence that were attributed to the intervention. Four studies considering the use of information and communication technology observed no changes in medication adherence. Interventions that coordinate and manage healthcare processes may help improve patients' adherence to medication regimes in those with mental-physical multimorbidity. However, it is still necessary to better understand how digital health technology can support patients in following their medication regimes. As the growing challenges of treating multimorbidity are faced, everyone involved in health services - from providers to policymakers - must be receptive to a more integrated approach to healthcare delivery.

Nurse-led Interventions to Enhance Adherence to Chronic Medications

Introduction: Chronic diseases require long-term medication adherence to achieve optimal health outcomes, yet non-adherence remains a significant challenge. Nurse-led interventions have been proposed as a strategy to enhance adherence. This systematic review aimed to evaluate the effectiveness of nurse-led interventions in improving medication adherence among patients with chronic conditions. Methods: A comprehensive literature search was conducted across several databases, including PubMed, Embase, CINAHL, Cochrane Library, and PsycINFO, for studies published up to 2022. Only interventional studies and clinical trials led by nurses focusing on chronic medication adherence were included. The selection process involved screening for relevance, assessing methodological quality, and extracting data on adherence rates, intervention types, and patient outcomes. Results: Eight studies met the inclusion criteria, revealing a variety of nurse-led interventions, such as personalized counseling, telehealth follow-ups, educational workshops, and digital reminders. Sample sizes ranged from 30 to over 500 participants. The interventions demonstrated a significant improvement in medication adherence, with increases ranging from 15% to 25%. Specific interventions, like personalized care plans and technology-enhanced strategies, showed particular promise. Comparative analysis with other non-nurse-led interventions in the literature suggested that nurse-led approaches are at least as effective, with some evidence indicating superior outcomes in certain contexts. Conclusions: Nurse-led interventions are effective in enhancing medication adherence among patients with chronic diseases. The review highlights the importance of personalized and technology-enhanced approaches within these interventions. Despite limitations such as study heterogeneity and potential publication bias, the findings support the integration of nurse-led strategies into clinical practice to improve chronic disease management. Future research should focus on identifying the most effective components of these interventions across diverse patient populations.

Effectiveness of an algorithm-driven home telemonitoring system on the metabolic control and self-care behaviour of Asian adults with type-2 diabetes mellitus: A randomised controlled trial.

Healthcare professionals are leveraging on telehealth to manage patients with type-2 diabetes mellitus (T2DM). This study aimed to determine the clinical outcomes of patients using a novel tele-monitoring system (OPTIMUM) as compared to the standard of care. An open-labelled randomised controlled trial involving 330 Asian patients with T2DM, aged 26-65 years, and suboptimal glycaemic control (HbA1c = 7.5-10%) was conducted in a Singapore public primary care clinic. The patients were assigned in a 1:1 ratio by block randomization to the intervention group to receive: in-app video-based tele-education, tele-monitoring of the blood pressure (BP), capillary glucose and weight via Bluetooth devices and mobile application, followed by algorithm-based tele-management by the OPTIMUM telehealth care team for abnormal parameters. Patients received usual care in the control group. Clinical assessments and self-care-related questionnaires were administered for both groups at baseline and 6 months. Complete data of 159 (intervention) and 160 (control) patients with comparable demographic profiles were analysed. Those in the intervention group showed significantly lower HbA1c by 0.34% (95%CI = -0.57 to -0.11; p = 0.004); first measurement of systolic BP decreased by 2.98 mmHg (95%CI:-5.8 to -0.08; p = 0.044) and diastolic BP by 4.24 mmHg (95%CI = -6.0 to -2.47; p = 0.001); and total cholesterol by 0.18 mmol/L (95%CI: -0.34 to -0.01; p = 0.040) compared to the control group, after adjusting for baseline variables. Questionnaire scores showed significant improvements in medication adherence and self-care behaviour in the intervention group. No significant weight change was noted between groups. The OPTIMUM tele-monitoring system improved the glycaemic, BP and total cholesterol control in patients with suboptimal T2DM control by enhancing their medication adherence and self-care over 6 months.

A systematic review of interventions to improve medication adherence in family medicine patients

Background: Medication non-adherence poses a significant challenge in healthcare, leading to suboptimal treatment outcomes. This systematic review aims to evaluate the effectiveness of different interventions in improving medication adherence. Methodology: A comprehensive search was conducted to identify relevant studies. Inclusion criteria encompassed interventions targeting medication adherence and reporting quantitative measures of adherence outcomes. The selected studies were assessed for quality, and data were extracted for analysis. Results: The review included a total of 14 studies. Interventions involving tailored phone calls or educational materials did not yield significant improvements in medication adherence. Conversely, interventions such as face-to-face counseling sessions and self-management programs showed promise in improving adherence. Nurse-led interventions and pharmacist-led consultations did not demonstrate significant improvements. Similarly, interventions involving stroke physician specialist assessments, behavioral feedback, medication reviews, and motivational interviewing did not yield significant improvements. A pooled analysis of various interventions across different healthcare settings showed a moderate but not statistically significant difference in medication adherence. Conclusion: The findings from this systematic review suggest that interventions tailored to individual patient characteristics and involving personalized support and education show promise in improving medication adherence. However, interventions relying solely on tailored phone calls, educational materials, nurse-led care, pharmacist-led consultations, stroke physician specialist assessments, behavioral feedback, medication reviews, or motivational interviewing may not consistently improve adherence. Keywords: Medication Adherence, Patient Compliance, Family Medicine, Education, Behavioral Modification.

Examining the Use of a Polypill in Cardiovascular Disease Prevention.

Cardiovascular disease (CVD) is a significant cause of death worldwide. To address the global burden of CVD and its risk factors, the polypill, an all-in-one therapy that combines multiple existing medications for preventing CVD and reducing CVD events (such as angiotensin-converting enzyme inhibitor, beta-blocker, statin, or aspirin) into a single combination pill, has emerged as a potential strategy to improve CVD prevention. Clinical trials on the polypill have found that polypill use is associated with significant reductions in CVD events and risk factors in both patients with established CVD and at risk of developing CVD, suggesting a potential benefit in primary and secondary CVD prevention. The polypill has also been demonstrated to be a cost-effective therapy that may potentially increase treatment accessibility, affordability, and availability particularly in low- and middle-income countries. Further, patients on polypill therapy have shown high rates of treatment compliance, with significant improvements in medication adherence for patients with low baseline compliance. Given its potential advantages and benefits, the polypill may become a promising therapy for the prevention of CVD.

Effects of mobile apps intervention on medication adherence and type 2 diabetes mellitus control: A systematic review and meta-analysis.

The prevalence of non-adherence to antidiabetic treatment remains high despite various efforts. Thus, the positive effects of the antidiabetic treatment cannot be optimised and the disease progresses to complications. This present systematic review and meta-analysis aimed to evaluate the effects of mobile applications (apps) intervention on medication adherence and type 2 diabetes mellitus (T2DM) control. This research was conducted following the PRISMA guidelines. The databases that had been searched included Web of Science, PubMed, Scopus, Cochrane Library and Ovid from 2017 to 2022. Study characteristics were retrieved and study outcomes such as adherence status and diabetes control were extracted and quantitatively analysed through meta-analysis. Eight studies met the final inclusion criteria and were included in the analysis, contributing to a total of 884 subjects. The methodological quality of the included studies was variable. Three studies reported statistically significant improvement in medication adherence through mobile apps intervention. Additionally, the mobile apps intervention proved effective in reducing glycaemic outcomes. As compared to non-mobile apps users, glycated haemoglobin (HbA1c) significantly decreased by 0.36% (95% CI -0.47% to -0.25%), whereas fasting plasma glucose (FPG) significantly decreased by 16.75 mg/dL (95% CI -17.60 mg/dL to -15.80 mg/dL). Mobile apps intervention had beneficial impacts on medication adherence and glycaemic parameters. Future research should explore the best practical approach for real-world settings.

What is the effect of mobile phone text message reminders on medication adherence among adult type 2 diabetes mellitus patients: a systematic review and meta-analysis of randomized controlled trials

BackgroundGlobally, type 2 diabetes has become increasing. As little is known about the effect of educational intervention on this population, this systematic review and meta-analysis evaluated the effectiveness of mobile phone text message reminders versus usual care to improve medication adherence among type 2 diabetes mellitus patients.MethodsPubMed, Google Scholar, Cochrane Library, Scopus, and African Journals Online, were searched. A random-effects model was employed to estimate combined effect sizes. Subgroup analyses were employed to investigate possible sources of heterogeneity between studies. The overall certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach.ResultsA total of 9 trials with 1,121 participants were included in the review. The pooled estimated impact of mobile phone text message reminders on medication adherence was (SMD: 0.36; 95%CI; 0.14, 0.59) compared to usual care groups among patients with type 2 diabetes mellitus. In addition, subgroup analyses revealed greater medication adherence levels in those studies with intervention durations of more than six months and with self-report/refill adherence scale measurement (SMD: 0.21; 95%CI: 0.02, 0.40) and (SMD: 0.45; 95%CI: 0.22, 0.68), respectively.ConclusionMobile phone text messages can potentially lead to improved medication adherence levels in patients with Type 2 diabetes despite heterogeneity across the studies. Therefore, mobile phone text messaging when delivered in addition to usual care, have the potential to produce significant improvements in medication adherence.

Effectiveness of nurse-led interventions on medication adherence in adults taking medication for metabolic syndrome: A systematic review and meta-analysis.

To determine the effectiveness of nurse-led interventions on medication adherence, medication knowledge and clinical outcomes in adults taking medication for metabolic syndrome. Despite the significance of interventions designed to improve medication adherence, a systematic review of nurse-led intervention studies for metabolic syndrome is lacking. A systematic review and meta-analysis of randomised controlled trials. The study was conducted following the PRISMA guidelines checklist. PubMed, EMBASE, PsychINFO, CINAHL, Cochrane CENTRAL and other manual sources were searched in May 2021.The quality assessment was conducted using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Comprehensive Meta-Analysis 3.0 was used to calculate the pooled effect sizes with 95% confidence intervals. This review included 20 studies of nurse-led medication adherence interventions in 6017 adults at risk for metabolic syndrome. The pooled effect size using the random effects model indicated that nurse-led interventions had a significantly moderate impact on enhancing medication adherence and medication knowledge and improving selected clinical outcomes of available studies in nurse-led intervention groups compared with control groups. Duration of intervention (median 12 weeks), mode of delivery (group vs. individual) and using multiple strategies influenced outcomes of nurse-led medication adherence interventions. The results revealed that interventions of moderate- to high-quality studies were more likely to show significant improvements in medication adherence than those of low-quality studies. The meta-analyses showed that nurse-led interventions may enhance medication adherence and knowledge and improve clinical outcomes of this population. The findings may contribute to evidence-based information about nurse-led intervention and its selection of appropriate interventions for improving medication adherence in this population. Patients or the public were not directly involved in this review.

Interventions Incorporating Therapeutic Alliance to Improve Medication Adherence in Black Patients with Diabetes, Hypertension and Kidney Disease: A Systematic Review.

Black Americans have a disproportionately increased risk of diabetes, hypertension, and kidney disease, and higher associated morbidity, mortality, and hospitalization rates than their White peers. Structural racism amplifies these disparities, and negatively impacts self-care including medication adherence, critical to chronic disease management. Systematic evidence of successful interventions to improve medication adherence in Black patients with diabetes, hypertension, and kidney disease is lacking. Knowledge of the impact of therapeutic alliance, ie, the unique relationship between patients and providers, which optimizes outcomes especially for minority populations, is unclear. The role and application of behavioral theories in successful development of medication adherence interventions specific to this context also remains unclear. To evaluate the existing evidence on the salience of a therapeutic alliance in effective interventions to improve medication adherence in Black patients with diabetes, hypertension, or kidney disease. Medline (via PubMed), EMBASE (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL) (EBSCOhost), and PsycINFO (ProQuest) databases. Only randomized clinical trials and pre/post intervention studies published in English between 2009 and 2022 with a proportion of Black patients greater than 25% were included. Narrative synthesis was done. Eleven intervention studies met the study criteria and eight of those studies had all-Black samples. Medication adherence outcome measures were heterogenous. Five out of six studies which effectively improved medication adherence, incorporated therapeutic alliance. Seven studies informed by behavioral theories led to significant improvement in medication adherence. Study findings suggest that therapeutic alliance-based interventions are effective in improving medication adherence in Black patients with diabetes and hypertension. Further research to test the efficacy of therapeutic alliance-based interventions to improve medication adherence in Black patients should ideally incorporate cultural adaptation, theoretical framework, face-to-face delivery mode, and convenient locations.

Clinical Pharmacist Led-Educational Intervention to Promote Medications' Adherence for Sudanese Patients with Heart Failure: A Prospective Study

Clinical pharmacists are in a suitable position to improve medications adherence for chronic diseases, including heart failure (HF). This study aimed to identify if the structured educational intervention by the clinical pharmacist can improve adherence to HF medications in a specialized HF clinic. Methods: A quasi-interventional study was implemented in an outpatient HF clinic for six months at Ahmed Gasim Cardiac Surgery and Renal Transplantation Center, Khartoum, Sudan. Adherence was assessed by using Morisky-4 Medication Adherence Scale (MMAS-4). Clinical pharmacist intervention using verbal and written materials composed of different aspects to promote medications adherence for HF were performed during the study period. Results: Among 110 patients, 97.3% were non-adherent to HF medications at baseline, with the exception of receiving education about HF; all sociodemographic and clinical characteristics of patients were not associated with the non-adherence status. Significant improvement in medication adherence was reported after clinical pharmacist intervention by different views of MMAS-4. There was a reduction in the total mean MMAS-4 score (2.64 ± 1.1 vs. 0.67 ± 0.9, P=0.001), and a significant increase in the percentage of patients having high adherence (2.7% vs. 56.4%, P=0.001) before and after clinical pharmacist intervention. By contrast, the proportion of patients with medium and low adherence was significantly reduced after intervention (42.7% vs. 37.3%, P=0.001) and (54.5% vs. 6.4%, P=0.001), respectively. Conclusion: Non-adherence was highly prevalent among Sudanese patients with HF; the clinical pharmacist led-educational intervention can improve medication adherence for HF medications.

Understanding strategies to improve medication adherence among persons with type 2 diabetes: A scoping review.

The objectives of this scoping review were to: (1) identify the target audience and contexts in which strategies to improve type 2 diabetes mellitus (T2DM) medication adherence have been used, (2) provide an overview of behaviour change techniques (BCTs) used, (3) describe the determinants of behaviour targeted by strategies and (4) to identify current gaps in strategies. A systemic search for articles related to T2DM, medication adherence and strategies was conducted in EMBASE, Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily using the OvidSP platform on 11 March 2021. All publications involving strategies to overcome medication non-adherence among adults with T2DM were included. Strategies were categorized according to the BCT taxonomy and the determinants of behaviour targeted by each strategy were classified by using the Theoretical Domains Framework (TDF). The search identified 58 articles and 61 strategies. The BCT categories Antecedents and Natural consequences and BCTs Feedback on outcome(s) of behaviour, Adding objects to the environment and Information about health consequences were identified most frequently as components of strategies resulting in statistically significant improvement in medication adherence. Strategies targeting the TDF domains Reinforcement and Beliefs about Consequences most often resulted in statistically significant improvements in adherence measures. The findings from this review identify BCTs and targeted behaviours with demonstrated success. Further exploration of the myriad of BCTs and the corresponding determinants of behaviour which were not accessed may be warranted for the development of future strategies to improve medication adherence in type 2 diabetes.

Systematic Literature Review of Text Messaging Interventions to Promote Medication Adherence Among People With Serious Mental Illness.

Mobile health tools are feasible options to encourage behavior change among patients with serious mental illness. Mobile health tools vary widely, both in platforms used and content delivered. This literature review assessed the use of text messaging interventions to promote medication adherence among patients with serious mental illness. A systematic literature review using PRISMA guidelines examined short message service (SMS) text messaging interventions promoting medication adherence to people with a serious mental illness diagnosis. Databases included PubMed, Cochrane, CINAHL, and PsycINFO. Data extraction included demographic information, participant diagnoses, intervention components, medication class, adherence measures, research design, and study outcomes. Study quality was also assessed. Of 114 full-text articles screened, 10 articles were selected from nine unique interventions (N=937 people with serious mental illness). Study durations ranged from 30 days to 18 months, with frequency of SMS ranging from twice weekly to 12 times daily. Of the nine unique trials, most reported using an automated server to deliver SMS messages (N=7), two-way SMS capabilities (N=6), customized message content or timing (N=7), and additional components (e.g., provider contact, educational content, and monetary rewards) (N=7). Seven of the 10 articles reported statistically significant improvement in medication adherence and in at least one clinical outcome. Evidence to date indicates that text messaging interventions are feasible and appear to improve medication adherence and clinical outcomes among patients with serious mental illness. Future research should assess implementation approaches and how to scale up efforts in nonresearch settings.

Cost-Effectiveness Analysis: Personal Systems Approach in Improving Medication Adherence in Adult Kidney Transplant Patients.

Interventions to improve medication nonadherence in transplantation have recently moved from a focus on motivation and intention, to a focus on person-level quality improvement strategies. These strategies link adherence to established daily routines, environmental cues, and supportive people. The objective of this evaluation was to estimate the cost of implementation and the cost-effectiveness of a person-level intervention shown to increase medication adherence. To estimate the intervention costs, a direct measure microcosting approach was used after key informant interviews with project champions and a review of implementation expenditures. Cost-effectiveness was calculated by comparing the incremental implementation costs and healthcare costs associated with nonadherence to the incremental percent adherent, defined as the percent of patients who took greater or equal to 85% of their medication doses, for each pairwise comparison. The intervention was low-resource to implement, costing approximately $520 to implement per patient, and was associated with significant improvements in medication adherence. These implementation costs were more than outweighed by the expected healthcare savings associated with improvements in adherence. This person-level intervention is a low-cost, efficacious intervention associated with significant statistical and clinical improvements in medication adherence in adult kidney transplant recipients.

Impact of patient counselling on perception and medication adherence of hypertensive patients with chronic kidney disease

Chronic Kidney Disease is a progressive and irreversible loss of renal function. The purpose of the study was to understand how patient counselling affects patient perception, and medication adherence and to identify the risk factors of medication non-adherence. A Cross-sectional prospective study was done among 109 hypertensive patients with Chronic Kidney Disease for 6 months. All study participants were interviewed to obtain detailed socio-demographic and medical data. Patient counselling was provided in two sessions. Patients were asked to fill out the Knowledge, Attitude, Practice questionnaire, and the Morisky Medication Adherence Scale -8 pre and post counselling. Patient information leaflets were provided at the end of the eighth week. The study results show that in the mean Knowledge, Attitude, Practice score, there was a significant increase in total knowledge from a baseline of 0.79±0.77 to 1.22±0.69 at the end of the fourth week and 1.57±0.54 at the end of the eighth week. The mean adherence was improved from 0.38±0.55 to 0.67±0.67 to 1.10±0.57, indicating a significant improvement in medication adherence with continuous patient counselling. The most common reason for non-adherence was forgetfulness. Poor adherence to treatment and lack of knowledge remains a major obstacle in the management of Chronic Kidney Disease patients. Hypertension, diabetes, and cardiovascular disorders remain the leading causes of Chronic Kidney Disease.

Use of the transtheoretical model in medication adherence: A systematic review.

Medication nonadherence is an important public health issue that has individual and system-level implications. Nonadherence can lead to negative health outcomes and illness, which in turn produce increased healthcare costs for both the individual and system. The transtheoretical model of change (TTM) can be a useful basis for interventions, as it can identify patients' current stages of change and guide them from nonadherence to adherence. The objective of this systematic review was to determine the utilization of the TTM to predict or improve medication adherence in patients with chronic conditions. A systematic review of current literature was conducted to obtain an overview of the use of TTM-informed interventions for medication adherence in chronic conditions. PubMed, Embase, PsycInfo and CINAHL databases were searched in July 2020. The methodological quality of the studies was evaluated using the Downs and Black checklist. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for data extraction, analysis, and reporting. Ten studies were included in the final data synthesis of this review. Eight of the reviewed studies supported the utility of TTM to predict or improve medication adherence in patients with chronic conditions, while two studies did not find any significant improvement in medication adherence after using a TTM-based intervention. The Downs and Black checklist revealed the overall methodological quality of the included studies to be fair [mean (SD)=16.3 (4.5) of a possible maximum score of 28]. This systematic review provides an overview of the utility of TTM in predicting and improving medication adherence in patients with chronic conditions. Although TTM-based interventions in patients with low or moderate medication adherence were effective, there were few studies identified, suggesting the need for further research.

Pharmacist-Led Interventions to Improve Medication Adherence in Older Adults: A Meta-Analysis

As pharmacists work to ensure reimbursement for chronic disease management services on the national (e.g., Medicare) level, summative evidence of their impact on important health metrics, such as medication adherence, is needed. The objective of this study was to assess the effectiveness of pharmacist-led interventions on medication adherence in older adults. In April 2020, a comprehensive search was conducted in six databases for publications of randomized clinical trials of pharmacist-led interventions to improve medication adherence in older adults. English-language studies with codable data on medication adherence and diverse adherence-promoting interventions targeting older adults (age 65+) were eligible. A standardized mean difference effect size (intervention vs. control) was calculated for the medication adherence outcome in each study. Study effect sizes were pooled using a random-effects meta-analysis model. Moderator analyses were then conducted to explore for differences in effect size due to intervention, sample, and study characteristics. The primary outcome was medication adherence using any method of measurement. This meta-analysis included 40 unique randomized trials of pharmacist-led interventions with data from 8,822 unique patients (mean age, range: 65 to 85 years). The mean effect size was 0.57 (95% Confidence Interval [CI]: 0.38-0.76). When two outlier studies were excluded from the analysis, the mean effect size decreased to 0.41 (95% CI: 0.27-0.54). Moderator analyses showed larger effect sizes for interventions containing medication education and when interventions had components delivered at least partly in patients’ homes. In conclusion, this meta-analysis found a significant improvement in medication adherence among older adults receiving pharmacist-led interventions.

Effect of Lockdown on Diabetes Care During the COVID-19 Pandemic: Result of a Telephone-Based Survey Among Patients Attending a Diabetic Clinic in Northern India.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has aggravated the demand for diabetes care due to restrictive measures like the lockdown affecting access to healthcare services. The current study was conducted to assess the changes in medication compliance, dietary pattern, and glucose monitoring during the lockdown period as compared to the pre-lockdown period among patients living with type 2 diabetes mellitus (T2DM) attending a diabetes clinic in northern India.MethodsThis cross-sectional study was conducted between May and July 2020. Information regarding the sociodemographic and clinical profiles of the patients like age, sex, income, qualification, family history of diabetes, history of smoking and alcohol, type of treatment, co-morbidities, drug adherence for T2DM, changes in the pattern of diet, physical activity, blood glucose monitoring, and drug usage during and before the lockdown was collected through telephonic interviews using a structured tool. Descriptive analysis was performed, and the chi-square and Wilcoxon sign ranks tests were used to see the association between variables.ResultsA total of 260 patients were enrolled in the study. A higher proportion of males reported a decrease in the consumption of cereals (13.9%), eggs (56.5%), and meat and fish (92.7%) and an increase in water intake (25.8%) while a higher proportion of females reported no change in physical activity levels (77.2%) during the lockdown against pre-COVID times. There was a significant improvement in medication adherence and glycemic control during the lockdown period as compared to the pre-lockdown times.ConclusionMore time for self-care, adequate counseling about glycemic goals, and knowledge of self-monitoring of blood glucose levels helped the majority of patients in adopting a healthy lifestyle and achieve better glycemic control during the COVID-19 lockdown.