Nurse-led interventions to enhance adherence to chronic medication: systematic review and meta-analysis of randomised controlled trials.
OBJECTIVE
Non-adherence to chronic medication remains an important problem with vast consequences and without solutions to date. Nurses are well positioned to provide adherence care, yet currently represent an underutilised force in improving adherence and outcomes. This review aims to synthesise the effect of nurse-led interventions on adherence to chronic medication.


METHODS
Using Review Manager software, a meta-analysis was conducted. The search term medication adherence was combined with random* and nurse in PubMed and ISI Web of Knowledge. Retrieved articles' reference lists were hand searched. Included were randomised controlled trials on nurse-led interventions, aiming to improve chronic medication adherence. Articles were to be in English and published from 2006 to 2011. Quality was assessed using an adapted version of the CONSORT tool.


RESULTS
Ten studies met the selection criteria, seven of which were on HIV-positive patients. Their quality was acceptable to high. Counselling was the intervention most frequently assessed, mostly given face-to-face, but also in groups and via electronic messages. All interventions enhanced adherence. Of the five studies reporting adherence as mean percentage of adherence, pooled mean differences were +5.39 (1.70-9.07) (short term) and +9.49 (4.68-14.30) (long term), favouring the intervention groups. Of the studies reporting adherence dichotomously, odd's ratios were 1.55 (1.04-2.29) (short term) and 1.87 (1.35-2.61) (long term). The longer counselling was effectuated, the better the results.


CONCLUSIONS
Counselling appears to be an effective approach that nurses can use to supplement other methods, building a multifaceted strategy to enhance adherence. Tackling non-adherence seems to demand continuous efforts and follow-up.
Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, CDE R334, Universiteitsplein 1,Wilrijk, 2610 Antwerp, Belgium. yoleen@gmail.com
Yoleen P
YP
Van Camp
Bart
B
Van Rompaey
Monique M
MM
Elseviers
D002908:Chronic Disease / Q000188:drug therapy / Q000451:nursing; D006801:Humans; D009723:Nurse-Patient Relations; D010353:Patient Education as Topic / Q000458:organization & administration; D016032:Randomized Controlled Trials as Topic / Q000451:nursing; D013997:Time Factors; D016903:Drug Monitoring