title: Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings.
abstract: OBJECTIVE
  Patient-centered approaches to improving medication adherence hold promise, but evidence of their effectiveness is unclear. This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains: shared decision-making, methods to enhance effective prescribing, systems for eliciting and acting on patient feedback about medication use and treatment goals, and medication-taking behavior.
  
  
  METHODS
  We reviewed literature on interventions that fell into these domains and were published between January 2007 and May 2013. Two reviewers abstracted information and categorized studies by intervention type.
  
  
  RESULTS
  We identified 60 studies, of which 40% focused on patient education. Other intervention types included augmented pharmacy services, decision aids, shared decision-making, and clinical review of patient adherence. Medication adherence was an outcome in most (70%) of the studies, although 50% also examined patient-centered outcomes.
  
  
  CONCLUSIONS
  We identified a large number of medication management interventions that incorporated patient-centered care and improved patient outcomes. We were unable to determine whether these interventions are more effective than traditional medication adherence interventions.
  
  
  CONCLUSIONS
  Additional research is needed to identify effective and feasible approaches to incorporate patient-centeredness into the medication management processes of the current health care system, if appropriate.
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, USA. Electronic address: Jennifer.l.kuntz@kpchr.org.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kuntz
authors.affiliation: Division Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.affiliation: Division Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA.
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
authors.affiliation: Partners Healthcare Systems, Inc., Wellesley, USA; Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
authors.forename: Shobha
authors.initials: S
authors.lastname: Phansalkar
authors.affiliation: Partners Healthcare Systems, Inc., Wellesley, USA; Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Slight
authors.affiliation: Partners Healthcare Systems, Inc., Wellesley, USA.
authors.forename: Qoua Liang
authors.initials: QL
authors.lastname: Her
authors.affiliation: Duke University, Durham, USA.
authors.forename: Nancy Allen
authors.initials: NA
authors.lastname: Lapointe
authors.affiliation: Duke University, Durham, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Mathews
authors.affiliation: Duke University, Durham, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: O'Brien
authors.affiliation: Cincinnati Children's Hospital and Medical Center, Cincinnati, USA.
authors.forename: William B
authors.initials: WB
authors.lastname: Brinkman
authors.affiliation: Cincinnati Children's Hospital and Medical Center, Cincinnati, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Hommel
authors.affiliation: The University of Oklahoma College of Pharmacy, Oklahoma City, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Farmer
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
authors.forename: Elissa
authors.initials: E
authors.lastname: Klinger
authors.affiliation: Partners Healthcare Systems, Inc., Wellesley, USA.
authors.forename: Nivethietha
authors.initials: N
authors.lastname: Maniam
authors.affiliation: Division Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Sobko
authors.affiliation: University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, USA.
authors.forename: Stacy C
authors.initials: SC
authors.lastname: Bailey
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
authors.forename: Insook
authors.initials: I
authors.lastname: Cho
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, USA.
authors.forename: Maureen H
authors.initials: MH
authors.lastname: Rumptz
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, USA.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Vandermeer
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, USA.
authors.forename: Mark C
authors.initials: MC
authors.lastname: Hornbrook
mesh_terms: D003657:Decision Making; D006801:Humans; D055118:Medication Adherence; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D018802:Patient-Centered Care; D012646:Self Administration
keywords: Adherence; Medications; Patient-centered care