Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review.
OBJECTIVE
This paper is a report of a literature review to identify research involving interventions to improve medication adherence in people with multiple co-existing chronic conditions. Title. Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. Background. The importance of managing co-existing, chronic conditions in people of all ages is critical to prevent adverse health outcomes.


METHODS
Databases, including Cumulative Index of Nursing and Allied Health Literature, Medline, PubMed and Web of Science were searched for the period January 1997-2007 using the combined keywords adherence, compliance, drug therapy, medication, clinical trial, randomized controlled trial, intervention, chronic condition, chronic disease, multiple morbidity and comorbidity. References of retrieved papers were also considered.


METHODS
The inclusion criteria were: English language, oral medication adherence, self-administered medications, multiple prescribed medications for three or more chronic conditions and randomized controlled trials lasting at least 3 months.


RESULTS
Studies examining medication adherence in people with multiple chronic conditions targeted people over 70 years of age, and were primarily focused on the management of polypharmacy and reducing healthcare costs. Adherence was measured using different tools and estimates of adherence, and interventions were predominantly delivered by pharmacists. The evidence for effective interventions to enhance medication adherence in multiple chronic conditions was weak, and psychosocial interventions were absent.


CONCLUSIONS
Interventions that improve medication adherence for people with multiple chronic conditions are essential, given the increased prevalence of these conditions in people of all ages. Outcomes of improved adherence, such as disease control and quality of life, require investigation. Psychosocial interventions engaging people in medication self-management offer potential for improved patient outcomes in complex diseases.
Williams
Allison
A
School of Nursing, The University of Melbourne, Carlton, Australia. afw@unimelb.edu.au
Manias
Elizabeth
E
Walker
Rowan
R
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000188:drug therapy* / Q000523:psychology; D018849:Controlled Clinical Trials as Topic; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D010353:Patient Education as Topic; D019338:Polypharmacy; D012646:Self Administration / Q000191:economics / Q000523:psychology