title: Strategies to improve adherence to medications for cardiovascular diseases in socioeconomically disadvantaged populations: a systematic review.
abstract: Medication non-adherence poses a major barrier to reducing cardiovascular disease (CVD) burden globally, and is increasingly recognised as a socioeconomically determined problem. Strategies promoting CVD medication adherence appear of moderate effectiveness and cost-effectiveness. Potentially, 'one-size-fits-all' measures are ill-equipped to address heterogeneous adherence behaviour between social groups. This review aims to determine the effects of strategies to improve adherence to CVD-related medications in socioeconomically disadvantaged groups. Randomised/quasi-randomised controlled trials (1996-June 2012, English), testing strategies to increase adherence to CVD-related medications prescribed to adult patients who may experience health inequity (place of residence, occupation, education, or socioeconomic position) were reviewed. 772 abstracts were screened, 111 full-text articles retrieved, and 16 full-text articles reporting on 14 studies, involving 7739 patients (age range 41-66 years), were included. Methodological and clinical heterogeneity precluded quantitative data synthesis. Studies were thematically grouped by targeted outcomes; underlying interventions and policies were classified using Michie et al.'s Behaviour Change Wheel. Contrasting with patient or physician/practice strategies, those simultaneously directed at patients and physicians/practices resulted in statistically significant improvements in relative adherence (16-169%). Comparative cost and cost-effectiveness analyses from three studies did not find cost-saving or cost-effective strategies. Unlike much current evidence in general populations, promising evidence exists about what strategies improve adherence in disadvantaged groups. These strategies were generally complex: simultaneously targeting patients and physicians; addressing social, financial, and treatment-related adherence barriers; and supported by broader guidelines, regulatory and communication-based policies. Given their complexity and potential resource implications, comprehensive process evaluations and cost and cost-effectiveness evidence are urgently needed.
authors: The George Institute for Global Health, Sydney, Australia. tlaba@georgeinstitute.org.au
authors: Tracey-Lea
authors: TL
authors: Laba
authors: Jonathan
authors: J
authors: Bleasel
authors: Jo-Anne
authors: JA
authors: Brien
authors: Alan
authors: A
authors: Cass
authors: Kirsten
authors: K
authors: Howard
authors: David
authors: D
authors: Peiris
authors: Julie
authors: J
authors: Redfern
authors: Abdul
authors: A
authors: Salam
authors: Tim
authors: T
authors: Usherwood
authors: Stephen
authors: S
authors: Jan
mesh_terms: D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000191:economics* / Q000208:ethnology; D003362:Cost-Benefit Analysis / Q000379:methods; D006801:Humans; D055118:Medication Adherence / Q000208:ethnology; D012959:Socioeconomic Factors; D035862:Vulnerable Populations / Q000208:ethnology
keywords: Cardiovascular disease; Medication adherence; Socioeconomic disadvantage