Inclusion of People with Disabilities in Research to Improve Medication Adherence: A Systematic Review

Abstract

People with disabilities have high rates of chronic health conditions and often require complex medication regimens to manage their health. Approximately 20-50% of people with disabilities fail to take their medication as prescribed. It is unclear, however, to what extent the literature describes the effectiveness of medication adherence interventions for people with disabilities. In this review, the inclusion and exclusion criteria of the 182 studies included in the Cochrane Review on Interventions for Enhancing Medication Adherence were evaluated for their inclusion of people with disabilities. Of the studies, 1% excluded persons for hearing impairment, 3% for motor impairment, 7% for visual impairment, and 32% for cognitive impairment. Most studies (65%) did not exclude persons based on specific impairment. Medication event monitoring systems were used in 21% of studies, and investigators excluded people unable to use this device in 5% of studies. Caregiver assistance was an exclusion criteria in 4% of studies. Additional barriers like the ability of investigators to exclude persons based on their judgement were found. These barriers exist in addition to the known barriers affecting persons with disabilities, such as accessibility of research facilities and access to transportation. These data suggest that people with disabilities are systemically excluded from the medication adherence intervention literature. Subsequently, it cannot be assumed that current adherence interventions are effective for people with disabilities. More research is needed to understand how to address medication adherence for people with disabilities.

Shining a spotlight on the inclusion of disabled participants in clinical trials: a mixed methods study

“…has not yet reached a uni ed view [47][48] [49]. Exclusion criteria related to potential participants' ability to consent, including the type/degree of disability of disabled people, remain ambiguous.…”

‘Being disabled’ as an exclusion criterion for clinical trials: a scoping review

“…Another way in which PWDS are excluded is the use of comorbidities as exclusion criteria 6. There is a high correlation between chronic conditions and disability.…”

“…From a research perspective PWDs represent a large, heterogeneous subgroup that needs to be taken into consideration for both general health issues and their specific pathologies and needs; the exclusion of PWDs may weaken the external validity of research study results. Furthermore, without studies including PWDs, clinicians lack evidence of treatment applicability towards this large minority group determined to be effective in the general population 6…”

Call to Integrate Content Related to Disabilities Into Contemporary Pharmacy Curricula

“…11,13 Approximately 20-50% of all individuals with disabilities do not take their medications as prescribed. 14 Content related to disabilities can be integrated in various ways across the curricula. For example, faculty may seek volunteers with disabilities from the local community to visit classrooms to provide their unique perspectives regarding their health care experiences.…”