title: Healthcare information technology interventions to improve cardiovascular and diabetes medication adherence.
abstract: OBJECTIVE
  To determine the efficacy of healthcare information technology (HIT) interventions in improving adherence.
  
  
  METHODS
  Systematic search of randomized controlled trials of HIT interventions to improve medication adherence in cardiovascular disease or diabetes.
  
  
  METHODS
  Interventions were classified as 1-way patient reminder systems, 2-way interactive systems, and systems to enhance patient-provider interaction. Studies were subclassified into those with and without real-time provider feedback. Cohen's d effect sizes were calculated to assess each intervention's magnitude of effectiveness.
  
  
  RESULTS
  We identified 7190 articles, only 13 of which met inclusion criteria. The majority of included studies (54%, 7 studies) showed a very small ES. The effect size was small in 15%, large in 8%, and was not amenable to calculation in the remainder. Reminder systems were consistently effective, showing the largest effect sizes in this review. Education/counseling HIT systems were less successful, as was the addition of realtime adherence feedback to healthcare providers. Interactive systems were rudimentary and not integrated into electronic health records; they exhibited very small effect sizes. Studies aiming to improve patient-provider communication also had very small effect sizes.
  
  
  CONCLUSIONS
  There is a paucity of data about HIT's efficacy in improving adherence to medications for cardiovascular disease and diabetes, although simple patient reminder systems appear effective. Future studies should focus on more sophisticated interactive interventions that expand the functionality and capabilities of HIT and better engage patients in care.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA 02120, USA.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Misono
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Cutrona
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
authors.forename: Michael A
authors.initials: MA
authors.lastname: Fischer
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Stedman
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Liberman
authors.forename: Troyen A
authors.initials: TA
authors.lastname: Brennan
authors.forename: Sachin H
authors.initials: SH
authors.lastname: Jain
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000188:drug therapy*; D004363:Drug Utilization / Q000706:statistics & numerical data; D006801:Humans; D008491:Medical Informatics Applications; D016032:Randomized Controlled Trials as Topic; D017010:Reminder Systems / Q000706:statistics & numerical data*; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents