title: Interventions to improve osteoporosis medication adherence and persistence: a systematic review and literature appraisal by the ISPOR Medication Adherence & Persistence Special Interest Group.
abstract: This study aims to systematically review, critically appraise and identify from the published literature, the most effective interventions to improve medication adherence in osteoporosis. A literature search using Medline, EMBASE, Cochrane library, and Cumulative Index to Nursing and Allied Health Literature was undertaken to identify prospective studies published between January 1, 1999 and June 30, 2012. We included studies on adult users of osteoporosis medications that tested a patient adherence intervention (e.g., patient education, intensified patient care, different dosing regimens) and reported quantitative results of adherence. The Delphi list was modified to assess the quality of studies. Of 113 articles identified, 20 studies fulfilled the inclusion criteria. The most frequent intervention was education (n = 11) followed by monitoring/supervision (n = 4), drug regimens (n = 2), drug regimens and patient support (n = 1), pharmacist intervention (n = 1), and electronic prescription (n = 1). Although patient education improved medication adherence in four studies, two large-scale randomized studies reported no benefits. Simplification of dosing regimens (with and without patient support program) was found to have a significant clinical impact on medication adherence and persistence. Monitoring/supervision showed no impact on medication persistence while electronic prescription and pharmacist intervention increased medication adherence or persistence. In conclusion, this review found that simplification of dosing regimens, decision aids, electronic prescription, or patient education may help to improve adherence or persistence to osteoporosis medications. We identified wide variation of quality of studies in the osteoporosis area. The efficacy of patient education was variable across studies, while monitoring/supervision does not seem an effective way to enhance medication adherence or persistence.
authors: Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands, m.hiligsmann@maastrichtuniversity.nl.
authors: M
authors: M
authors: Hiligsmann
authors: M
authors: M
authors: Salas
authors: D A
authors: DA
authors: Hughes
authors: E
authors: E
authors: Manias
authors: F H
authors: FH
authors: Gwadry-Sridhar
authors: P
authors: P
authors: Linck
authors: W
authors: W
authors: Cowell
mesh_terms: D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D006801:Humans; D055118:Medication Adherence; D010024:Osteoporosis / Q000188:drug therapy*; D010353:Patient Education as Topic; D012107:Research Design
chemical_list: D050071:Bone Density Conservation Agents
references: J Gerontol Nurs. 2004 Jul;30(7):25-32
references: 15287324
references: Patient Educ Couns. 2010 Nov;81(2):155-60
references: 20400258
references: Osteoporos Int. 2006;17(5):664-71
references: 16437191
references: Value Health. 2012 Jul-Aug;15(5):604-12
references: 22867768
references: Osteoporos Int. 2012 Mar;23(3):1069-74
references: 21755401
references: Arch Intern Med. 2012 Mar 26;172(6):477-83
references: 22371876
references: N Engl J Med. 1990 May 3;322(18):1265-71
references: 2109197
references: Health Policy. 2010 Jul;96(2):170-7
references: 20153543
references: Int J Clin Pract. 2006 Aug;60(8):896-905
references: 16800837
references: Br J Clin Pharmacol. 2012 May;73(5):691-705
references: 22486599
references: Osteoporos Int. 2009 Dec;20(12):2127-34
references: 19499273
references: Value Health. 2010 Jun-Jul;13(4):394-401
references: 20102558
references: Osteoporos Int. 2011 Jun;22(6):1725-35
references: 20827547
references: J Clin Pharm Ther. 2011 Oct;36(5):557-67
references: 21916908
references: Am J Obstet Gynecol. 2010 Mar;202(3):236.e1-5
references: 20044067
references: Expert Opin Pharmacother. 2009 Oct;10(14):2303-15
references: 19640210
references: Mayo Clin Proc. 2006 Aug;81(8):1013-22
references: 16901023
references: Am J Med. 2009 Feb;122(2 Suppl):S3-13
references: 19187810
references: Clin Ther. 2009 Feb;31(2):421-35
references: 19302915
references: Am J Med Qual. 2007 Nov-Dec;22(6):445-56
references: 18006425
references: Am J Med. 2011 Jun;124(6):549-56
references: 21605732
references: Osteoporos Int. 2010 Nov;21(11):1943-51
references: 19967338
references: Am J Manag Care. 2009 Jul;15(7):417-24
references: 19589009
references: JAMA. 2002 Dec 11;288(22):2868-79
references: 12472329
references: Joint Bone Spine. 2012 Jul;79(4):389-92
references: 21703900
references: Osteoporos Int. 2011 Jun;22(6):1821-8
references: 20924747
references: Osteoporos Int. 2008 Jun;19(6):811-8
references: 17999022
references: J Clin Epidemiol. 1998 Dec;51(12):1235-41
references: 10086815
references: Am J Health Syst Pharm. 2012 Mar 15;69(6):504-9
references: 22382482
references: Calcif Tissue Int. 2010 Mar;86(3):202-210
references: 20063188
references: Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000011
references: 18425859
references: Value Health. 2007 Jan-Feb;10(1):3-12
references: 17261111
references: Bone. 2011 Feb;48(2):380-8
references: 20850576
references: J Clin Endocrinol Metab. 2007 Apr;92(4):1296-304
references: 17244788
references: Bone. 2006 Jun;38(6):922-8
references: 16330270
references: Osteoporos Int. 2010 Mar;21(3):391-8
references: 19499272
references: Osteoporos Int. 2012 Jan;23(1):317-26
references: 21927922
references: J Clin Endocrinol Metab. 2004 Mar;89(3):1117-23
references: 15001596
references: Am J Health Promot. 2002 Jan-Feb;16(3):146-56
references: 11802260