title: Modes of delivery for interventions to improve cardiovascular medication adherence.
abstract: OBJECTIVE
  To determine the optimal modes of delivery for interventions to improve adherence to cardiovascular medications.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  We conducted systematic searches of English-language, peer-reviewed publications in MEDLINE and EMBASE, 1966 through December 31, 2008. We selected randomized controlled trials of interventions to improve adherence to medications for preventing or treating cardiovascular disease or diabetes. Articles were classified based on mode of delivery of the main intervention as (1) person-independent interventions (mailed, faxed, or hand distributed; or delivered via electronic interface) or (2) person-dependent interventions (nonautomated phone calls, in-person interventions).
  
  
  RESULTS
  We identified 6550 articles. Of these, 168 were reviewed in full and 51 met inclusion criteria. Among person-independent interventions (56% successful), electronic interventions were most successful (67%). Among person-dependent interventions (52% successful), phone calls showed low success rates (38%). In-person interventions at hospital discharge were more effective (67%) than clinic interventions (47%). In-person pharmacist interventions were effective when held in a pharmacy (83% successful), but were less effective in clinics (38%).
  
  
  CONCLUSIONS
  Future medication adherence studies should explore new electronic approaches and in-person interventions at the site of medication distribution. Identifying times of increased patient receptivity to the adherence message such as hospital discharge also will be important.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, 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: Michael A
authors.initials: MA
authors.lastname: Fischer
authors.forename: Amber
authors.initials: A
authors.lastname: Servi
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Liberman
authors.forename: Troyen A
authors.initials: TA
authors.lastname: Brennan
authors.forename: William H
authors.initials: WH
authors.lastname: Shrank
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D003142:Communication; D003920:Diabetes Mellitus / Q000188:drug therapy*; D037001:Directive Counseling; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D010351:Patient Discharge; D010353:Patient Education as Topic / Q000379:methods*; D010594:Pharmacies; D055553:Prescription Drugs; D011369:Professional-Patient Relations; D013689:Telephone; D014481:United States; D016903:Drug Monitoring
chemical_list: D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D055553:Prescription Drugs