title: Targeting cardiovascular medication adherence interventions.
abstract: OBJECTIVE
  To determine whether adherence interventions should be administered to all medication takers or targeted to nonadherers.
  
  
  METHODS
  Systematic search (Medline and Embase, 1966-2009) of randomized controlled trials of interventions to improve adherence to medications for preventing or treating cardiovascular disease or diabetes.
  
  
  METHODS
  Articles were classified as (1) broad interventions (targeted all medication takers), (2) focused interventions (targeted nonadherers), or (3) dynamic interventions (administered to all medication takers; real-time adherence information targets nonadherers as intervention proceeds). Cohen's d effect sizes were calculated.
  
  
  RESULTS
  We identified 7,190 articles; 59 met inclusion criteria. Broad interventions were less likely (18%) to show medium or large effects compared with focused (25%) or dynamic (32%) interventions. Of the 33 dynamic interventions, 6 used externally generated adherence data to target nonadherers. Those with externally generated data were less likely to have a medium or large effect (20% vs. 34.8% self-generated data).
  
  
  CONCLUSIONS
  Adherence interventions targeting nonadherers are heterogeneous but may have advantages over broad interventions. Dynamic interventions show promise and require further study.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, USA. sarah.cutrona@umassmemorial.org
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 D
authors.initials: AD
authors.lastname: Servi
authors.forename: Margaret
authors.initials: M
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: William H
authors.initials: WH
authors.lastname: Shrank
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D003627:Data Interpretation, Statistical; D006801:Humans; D055118:Medication Adherence; D010349:Patient Compliance; D016032:Randomized Controlled Trials as Topic
chemical_list: D002317:Cardiovascular Agents