The Effectiveness of Medication Adherence Interventions Among Patients With Coronary Artery Disease

Abstract

Background Despite the known benefits of medication therapy for secondary prevention of coronary artery disease (CAD), many patients do not adhere to prescribed medication regimens. Medication nonadherence is associated with poor health outcomes and higher health care cost. Objective The purpose of this meta-analysis was to determine the overall effectiveness of interventions designed to improve medication adherence (MA) among adults with CAD. Additionally, sample, study design, and intervention characteristics were explored as potential moderators to intervention effectiveness. Methods Comprehensive search strategies facilitated identification of two-group, treatment versus control design studies testing MA interventions among patients with CAD. Data were independently extracted by two trained research specialists. Standardized mean difference effect sizes were calculated for eligible primary studies, adjusted for bias, then synthesized under a random effects model. Homogeneity of variance was explored using a conventional heterogeneity statistic. Exploratory moderator analyses were conducted using meta-analytic analogues for ANOVA and regression for dichotomous and continuous moderators, respectively. Results Twenty-four primary studies were included in this meta-analysis. The overall effect size of MA interventions, calculated from 18,839 participants, was 0.229 (p<.001). The most effective interventions utilized nurses as interventionists, initiated interventions in the inpatient setting, and informed providers of patients' medication adherence behaviors. MA interventions tested among older patients were more effective than those among younger patients. Interventions were equally effective regardless of number of intervention sessions, targeting MA behavior alone or with other behaviors, and the use of written instructions only. Conclusions Interventions to increase medication adherence among patients with CAD were modestly effective. Nurses can be instrumental in improving MA among these patients. Future research is needed to investigate nurse-delivered MA interventions across varied clinical settings. Additionally, more research testing MA interventions among younger populations and more racially diverse groups is needed.

Interventions to Improve Medication Adherence in Hypertensive Patients: Systematic Review and Meta-analysis

“…The overall mean effect size of 0.300, which was calculated across 108 treatment vs. control comparisons, documents that treatment subjects had significantly better medication adherence outcomes than control subjects. This value was comparable to effect sizes reported in meta-analyses of adherence interventions conducted in general populations ( d = 0.18 to 0.37) [147, 148]; among older adults ( d = 0.33) [149]; adults with coronary artery disease ( d = 0.229) [150]; adults with heart failure ( d = 0.29) [151]; patients with adherence problems ( d = 0.301) [152]; and in targeted populations of underrepresented racial/ethnic groups ( d = 0.211) [153]. …”

“…The results also suggest that interventions can target multiple health behaviors without adversely affecting adherence outcomes [150]. This is important information for hypertensive populations in which other health behaviors affecting cardiovascular health such as diet and exercise must also be addressed.…”

Examining overlap of included studies in meta‐reviews: Guidance for using the corrected covered area index

“…Consider what might happen, on the other hand, if the meta‐review was reporting outcomes within a more focused health behavior domain, for example, cardiovascular disease (CVD) prevention and treatment. In our empirical example, when we focus on the seven meta‐analyses in the domain of CVD prevention and treatment, the CCA remains fairly minimal (ie, still less than 2%). Yet, within three of these reviews that focused on CVD, overlap was much higher (12%); they shared the same seven primary studies, and, two of these three reviews shared an additional six studies (the total unique k included across the three reviews was 98).…”

Behaviour change interventions to improve medication adherence in patients with cardiac disease: Protocol for a mixed methods study including a pilot randomised controlled trial

“…Medication adherence interventions for patients with CVD have been shown to be effective when delivered by nurses, who should play an active role in designing and applying such interventions (Albert, 2008;Chase et al, 2016). A recent systematic review emphasised that cardiac rehabilitation and prevention programs should encompass a dedicated strategy for medication adherence; at present, the majority of these programs do not measure and report adherence outcomes appropriately (Santo et al, 2016).…”

“…Prescription medications, an important form of secondary prevention for CVD, have been a key factor in the 20% reduction seen in mortality rates within one year of diagnosis of acute myocardial infarction (AMI) (Chase, Bogener, Ruppar, & Conn, 2016); and the 28% reduction within three months of AMI between 2006 and (Kolandaivelu, Leiden, Gara, & Bhatt, 2014). While cardiac medications have been shown to be effective for symptom management and slowing the progression of CVD, consistent adherence to prescribed medication regimes is required to achieve these effects (Hunt et al, 2009).…”