title: Physician effectiveness in interventions to improve cardiovascular medication adherence: a systematic review.
abstract: BACKGROUND
  Medications for the prevention and treatment of cardiovascular disease save lives but adherence is often inadequate. The optimal role for physicians in improving adherence remains unclear.
  
  
  OBJECTIVE
  Using existing evidence, we set the goal of evaluating the physician's role in improving medication adherence.
  
  
  METHODS
  We conducted systematic searches of English-language peer-reviewed publications in MEDLINE and EMBASE from 1966 through 12/31/2008.
  
  
  METHODS
  We selected randomized controlled trials of interventions to improve adherence to medications used for preventing or treating cardiovascular disease or diabetes.
  
  
  METHODS
  Articles were classified as either (1) physician "active"-a physician participated in designing or implementing the intervention; (2) physician "passive"-physicians treating intervention group patients received patient adherence information while physicians treating controls did not; or (3) physicians noninvolved. We also identified studies in which healthcare professionals helped deliver the intervention. We did a meta-analysis of the studies involving healthcare professionals to determine aggregate Cohen's D effect sizes (ES).
  
  
  RESULTS
  We identified 6,550 articles; 168 were reviewed in full, 82 met inclusion criteria. The majority of all studies (88.9%) showed improved adherence. Physician noninvolved studies were more likely (35.0% of studies) to show a medium or large effect on adherence compared to physician-involved studies (31.3%). Among interventions requiring a healthcare professional, physician-noninvolved interventions were more effective (ES 0.47; 95% CI 0.38-0.56) than physician-involved interventions (ES 0.25; 95% CI 0.21-0.29; p < 0.001). Among physician-involved interventions, physician-passive interventions were marginally more effective (ES 0.29; 95% CI 0.22-0.36) than physician-active interventions (ES 0.23; 95% CI 0.17-0.28; p = 0.2).
  
  
  CONCLUSIONS
  Adherence interventions utilizing non-physician healthcare professionals are effective in improving cardiovascular medication adherence, but further study is needed to identify the optimal role for physicians.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA 02120, USA. slcutrona@gmail.com
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Cutrona
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
authors.forename: Margaret
authors.initials: M
authors.lastname: Stedman
authors.forename: Amber
authors.initials: A
authors.lastname: Servi
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Liberman
authors.forename: Troyen
authors.initials: T
authors.lastname: Brennan
authors.forename: Michael A
authors.initials: MA
authors.lastname: Fischer
authors.forename: M Alan
authors.initials: MA
authors.lastname: Brookhart
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
mesh_terms: D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000523:psychology; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D055118:Medication Adherence / Q000523:psychology; D010819:Physician's Role / Q000523:psychology; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000639:trends
chemical_list: D002317:Cardiovascular Agents
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