Patient-Centered Interventions to Improve Adherence to Statins: A Narrative Synthesis of Systematically Identified Studies

Abstract

Poor adherence to statins increases cardiovascular disease risk. We systematically identified 32 controlled studies that assessed patient-centered interventions designed to improve statin adherence. The limited number of studies and variation in study characteristics precluded strict quality criteria or meta-analysis. Cognitive education or behavioural counselling delivered face-to-face multiple times consistently improved statin adherence compared with control groups (7/8 and 3/3 studies, respectively). None of four studies using medication reminders and/or adherence feedback alone reported significantly improved statin adherence. Single interventions that improved statin adherence but were not conducted face-to-face included cognitive education in the form of genetic test results (two studies) and cognitive education via a website (one study). Similar mean adherence measures were reported for 17 intervention arms and were thus compared in a sub-analysis: 8 showed significantly improved statin adherence, but effect sizes were modest (+7 to +22 % points). In three of these studies, statin adherence improved despite already being high in the control group (82–89 vs. 57–69 % in the other studies). These three studies were the only studies in this sub-analysis to include cognitive education delivered face-to-face multiple times (plus other interventions). In summary, the most consistently effective interventions for improving adherence to statins have modest effects and are resource-intensive. Research is needed to determine whether modern communications, particularly mobile health platforms (recently shown to improve medication adherence in other chronic diseases), can replicate or even enhance the successful elements of these interventions while using less time and fewer resources.Electronic supplementary materialThe online version of this article (doi:10.1007/s40265-016-0640-x) contains supplementary material, which is available to authorized users.

Design and rationale for the “Me & My Heart” (eMocial) study: A randomized evaluation of a new smartphone‐based support tool to increase therapy adherence of patients with acute coronary syndrome

“…9 A recent systematic review on longterm treatment of cardiovascular risk factors suggests cognitive education or behavioral counseling in multiple face-to-face meetings may improve that patients' adherence. 7 Nevertheless, these approaches are not considered cost-effective due to their resource-intensive nature for patients and providers. Consequently, these practices have not been widely implemented into general health-care practice.…”

“…A key strategy to enhance adherence is better communication and face‐to‐face coaching by a health‐care professional, despite the fact that coaching sessions may not be sustainable from a cost perspective. Digital patient support has been proposed as a potential solution that could be effective at a sustainable cost …”

“…Among patients taking oral antiplatelet medication, a lack of awareness regarding their necessity is associated with patient‐reported non‐adherence . A recent systematic review on long‐term treatment of cardiovascular risk factors suggests cognitive education or behavioral counseling in multiple face‐to‐face meetings may improve that patients' adherence . Nevertheless, these approaches are not considered cost‐effective due to their resource‐intensive nature for patients and providers.…”

“…Nevertheless, these approaches are not considered cost‐effective due to their resource‐intensive nature for patients and providers. Consequently, these practices have not been widely implemented into general health‐care practice …”

“…Digital patient support has been proposed as a potential solution that could be effective at a sustainable cost. [7][8][9] The purpose of the "Me & My Heart" (eMocial) study is to evaluate if patient support via a smartphone-based app increases patients' adherence to treatment as compared to the current practice of providing information leaflets to the patients within the German health-care system.…”