title: Interventions promoting adherence to cardiovascular medicines.
abstract: BACKGROUND
  Cardiovascular diseases (CVDs) are a large burden on the healthcare system. Medicines are the primary treatment for these diseases; however, adherence to therapy is low. To optimise treatment and health outcomes for patients, it is important that adherence to cardiovascular medicines is maintained at an optimal level. Therefore, identifying effective interventions to improve adherence and persistence to cardiovascular therapy is of great significance.
  
  
  OBJECTIVE
  This paper presents a review of the literature on interventions used in the community setting which aim to improve adherence to cardiovascular medicines in patients with hypertension, dyslipidaemia, congestive heart failure or ischaemic heart disease.
  
  
  METHODS
  Several databases (Medline, EMBASE, PsychINFO, IPA, CINAHL, Pubmed, Cochrane) were searched for studies which were published from 1979-2009, evaluated interventions intended to improve adherence to cardiovascular medicines in the community setting, had at least one measure of adherence, and consisted of an intervention and comparison/control group.
  
  
  RESULTS
  Among 36 eligible studies (consisting of 7 informational, 15 behavioural, 1 social, and 13 combined strategy interventions), 17 (1 informational, 10 behavioural, and 6 combined) reported a significant improvement in adherence and/or persistence. Behavioural interventions were the most successful. Twenty-one studies (4 informational, 9 behavioural, and 8 combined) also demonstrated improvements in clinical outcomes, though, effects were frequently variable, contradictory and not related to changes in adherence.
  
  
  CONCLUSIONS
  Several types of interventions are effective in improving adherence and/or persistence within the CVD area and in the community setting. Behavioural interventions have shown the greatest success (compared to other types of interventions); and adding informational strategies has not resulted in further improvements in adherence. Improving adherence and persistence to cardiovascular medicines is a dynamic process that is influenced by many factors, and one which requires long term multiple interventions to promote medicine taking in patients.
authors.affiliation: Department of Pharmaceutical Sciences, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, FAFC Wentgebouw, Sorbonnelaan 16, 3584 CA, Utrecht, The Netherlands. j.vandalem@students.uu.nl
authors.forename: Judith
authors.initials: J
authors.lastname: van Dalem
authors.forename: Ines
authors.initials: I
authors.lastname: Krass
authors.forename: Parisa
authors.initials: P
authors.lastname: Aslani
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000188:drug therapy*; D003157:Community Pharmacy Services / Q000458:organization & administration*; D003376:Counseling / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D055118:Medication Adherence; D009042:Motivation; D009937:Organizational Objectives; D010353:Patient Education as Topic; D011369:Professional-Patient Relations; D016730:Program Development; D012919:Social Behavior
chemical_list: D002317:Cardiovascular Agents