Medication adherence influencing factors—an (updated) overview of systematic reviews

Abstract

Background Non-adherence negatively affects the efficacy, safety and costs of therapies. Non-adherence is a multifactorial problem. This systematic review (SR) of SRs (overview) aims to identify factors that can influence the adherence of adult patients with chronic physical diseases. Methods We performed a systematic literature search in MEDLINE and Embase on June 13, 2018. We included SRs on the factors that can influence adherence in adult patients taking oral medications for treating physical chronic diseases. Two reviewers independently selected studies according to pre-defined inclusion criteria. Two reviewers independently assessed the risk of bias with the ROBIS tool. Data were extracted in standardized tables previously piloted by one reviewer and verified by a second reviewer. We synthesized data in tables in a structured narrative manner. Results We included 21 SRs on eight different conditions. We rated eight SRs to be at low risk of bias and 13 to be at high risk of bias. Although higher education, employment, higher financial status and marriage/partnership mostly showed a positive effect on adherence, the impact was unclear because of the high uncertainty of the underlying evidence. The evidence indicates that socioeconomic status and social support might have a positive impact on adherence and that belonging to an ethnic minority might have a negative impact on adherence. Therapy-related factors (e.g., intake regime) and disease-related factors (e.g., duration) mostly showed no impact on adherence. Analysis of gender showed inconsistent results. Age might have a concave relation to adherence, i.e., adherence is lowest in very young and very old people. Depression has a negative impact on adherence. Impacts of other mental and physical comorbidities were uncertain. Co-payments (any or higher) have a negative impact on adherence. In contrast, the impacts of medication costs and insurance status were uncertain. Conclusion This overview analyses factors that might impact adherence to oral therapies in adult patients with physical chronic diseases. Our overview suggests that there is a social gradient in adherence. However, for most factors, the evidence was not conclusive due to the risk of bias, inconsistency or imprecision. Electronic supplementary material The online version of this article (10.1186/s13643-019-1014-8) contains supplementary material, which is available to authorized users.

Non‐prescription medicines may contribute to non‐adherence to prescription medicines in people living with chronic health conditions

“…Both Laba et al and Al‐Ganmi et al also found no correlation with non‐adherence and therapy‐related factors . These are consistent with findings from the review by Gast and Mathes which found mostly no impact on adherence by therapy intake regimen . However, our study found a weak but statistically significant correlation between non‐adherence and the number of prescribed medicines, non‐prescription medications and total number of medications.…”

“…This study found a weak but statistically significant correlation between the number of missed doses and the patient's age, level of education and employment status. Similar to this, reviews of non‐adherence literature have found an association with age, education and employment . In contrast, Australian studies by Laba et al and Al‐Ganmi et al found no significant correlation between non‐adherence and demographic factors .…”

“…Systematic reviews have identified polypharmacy as a factor contributing to medication non‐adherence . However, a recent review by Gast and Mathes found the number of tablets had a negative impact on adherence in cardiovascular conditions but this impact was uncertain across other medical conditions . Similar to this, Smaje et al associated complex medication regimens with non‐adherence in four individual medical conditions (stroke, falls, sleep disturbance and chronic obstructive pulmonary disease) and also determined that higher levels of comorbidity were associated with poorer adherence .…”

The Consequences of General Medication Beliefs Measured by the Beliefs about Medicine Questionnaire on Medication Adherence: A Systematic Review

“…Although a number of systematic reviews have been conducted that aimed to identify factors that can influence medication adherence, including illness perceptions, specific medication beliefs, as well as culture and the demographic factors [ 6 , 17 , 18 , 19 ], none of these have explored the relationship between general beliefs about medicine determined through the BMQ and medication adherence of patients with chronic diseases such as HTN, COPD, asthma, and DMT2.…”

Main factors of adherence to new oral anticoagulants and its dynamics in outpatients with nonvalvular atrial fibrillation: results of the ANTEY study

“…В работе Khan MU и Aslani P [10], как и в исследовании АНТЕЙ, было выявлено, что к значимым факторам, влияющим на приверженность, относятся стоимость лечения и опасение развития ПЭ ЛП. В то же время, в систематическом обзоре Gast A и Mathes T [11] влияние на приверженность ПЭ ЛП не подтвердилось, что, вероятно, связано с описываемыми авторами ограничениями данного обзора -отсутствием анализа факторов, связанных с терапией, в связи с чем полученные результаты могли быть неполными.…”