Interventions to improve adherence and persistence with osteoporosis medications: a systematic literature review.
CONCLUSIONS
Adherence and persistence with osteoporosis medications are poor. We conducted a systematic literature review of interventions to improve adherence and persistence with osteoporosis medications. Seven studies met eligibility requirements and were included in the review. Few interventions were efficacious, and no clear trends regarding successful intervention techniques were identified. However, periodic follow-up interaction between patients and health professionals appeared to be beneficial.


BACKGROUND
Adherence and persistence with pharmacologic therapy for osteoporosis are suboptimal. Our goal was to examine the design and efficacy of published interventions to improve adherence and persistence.


METHODS
We searched medical literature databases for English-language papers published between January 1990 and July 2008. We selected papers that described interventions and provided results for control and intervention subjects. We assessed the design and methods of each study, including randomization, blinding, and reporting of drop-outs. We summarized the results and calculated effect sizes for each trial.


RESULTS
Seven studies met eligibility requirements and were included in the review. Five of the seven studies provided adherence data. Of those five studies, three showed a statistically significant (p < or = 0.05) improvement in adherence by the intervention group, with effect sizes from 0.17 to 0.58. Five of the seven studies provided persistence data. Of those five, one reported statistically significant improvement in persistence by the intervention group, with an effect size of 0.36.


CONCLUSIONS
Few interventions were efficacious, and no clear trends regarding successful intervention techniques were identified in this small sample of studies. However, periodic follow-up interaction between patients and health professionals appeared to be beneficial.
Gleeson
T
T
Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, PBB-B3, Boston, MA 02115, USA.
Iversen
M D
MD
Avorn
J
J
Brookhart
A M
AM
Katz
J N
JN
Losina
E
E
May
F
F
Patrick
A R
AR
Shrank
W H
WH
Solomon
D H
DH
D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006801:Humans; D010024:Osteoporosis / Q000188:drug therapy* / Q000523:psychology; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards; D012107:Research Design / Q000592:standards; D016896:Treatment Outcome; D016903:Drug Monitoring
D050071:Bone Density Conservation Agents