title: Improving medication adherence in chronic obstructive pulmonary disease: a systematic review.
abstract: Adherence to medication among individuals with chronic obstructive pulmonary disease (COPD) is suboptimal and has negative impacts on survival and health care costs. No systematic review has examined the effectiveness of interventions designed to improve medication adherence. Electronic databases Medline and Cochrane were searched using a combination of MeSH and keywords. Eligible studies were interventions with a primary or secondary aim to improve medication adherence among individuals with COPD published in English. Included studies were assessed for methodological quality using the Effective Practice and Organisation of Care (EPOC) criteria. Of the 1,186 papers identified, seven studies met inclusion criteria. Methodological quality of the studies was variable. Five studies identified effective interventions. Strategies included: brief counselling; monitoring and feedback about inhaler use through electronic medication delivery devices; and multi-component interventions consisting of self-management and care co-ordination delivered by pharmacists and primary care teams. Further research is needed to establish the most effective and cost effective interventions. Special attention should be given to increasing patient sample size and using a common measure of adherence to overcome methodological limitations. Interventions that involve caregivers and target the healthcare provider as well as the patient should be further explored.
authors.affiliation: Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, HMRI Building, University of Newcastle, Callaghan, NSW 2308, Australia. Jamie.Bryant@newcastle.edu.au.
authors.forename: Jamie
authors.initials: J
authors.lastname: Bryant
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: McDonald
authors.forename: Allison
authors.initials: A
authors.lastname: Boyes
authors.forename: Rob
authors.initials: R
authors.lastname: Sanson-Fisher
authors.forename: Christine
authors.initials: C
authors.lastname: Paul
authors.forename: Jessica
authors.initials: J
authors.lastname: Melville
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D055118:Medication Adherence; D009330:Nebulizers and Vaporizers; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012648:Self Care; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents