title: Impact of patient programs on adherence and persistence in inflammatory and immunologic diseases: a meta-analysis.
abstract: OBJECTIVE
  Patient adherence and persistence is important to improve outcomes in chronic conditions, including inflammatory and immunologic (I&I) diseases. Patient programs that aim at improving medication adherence or persistence play an essential role in optimizing care. This meta-analysis assessed the effectiveness of patient programs in the therapeutic area of I&I diseases.
  
  
  METHODS
  A global systematic literature review was conducted with inclusion criteria of: patient programs in I&I diseases; published in English language between January 2008 and September 2013; and reporting measures of adherence or persistence, including medication possession ratio >80% and persistence rate. A meta-analysis was performed using a random effects model. Subgroup analyses based on the type of program was performed whenever feasible.
  
  
  RESULTS
  Of 67 studies reviewed for eligibility, a total of 17 studies qualified for inclusion in the meta-analysis. Overall, patient programs increased adherence (odds ratio [OR]=2.48, 95% confidence interval [CI]=1.68-3.64, P<0.00001) as compared with standard of care. Combination patient programs that used both informational and behavioral strategies were superior in improving adherence (OR=3.68, 95% CI=2.20-6.16, P<0.00001) compared with programs that used only informational (OR=2.16, 95% CI=1.36-3.44, P=0.001) or only behavioral approaches (OR=1.85, 95% CI=1.00-3.45, P=0.05). Additionally, patients were more likely to be persistent (OR=2.26, 95% CI=1.16-4.39, P=0.02) in the intervention group as compared with the control group. Persistence (in days) was significantly (P=0.007) longer, by 42 additional days, in the intervention group than in the control group.
  
  
  CONCLUSIONS
  Patient programs can significantly improve adherence as well as persistence in the therapeutic area of I&I diseases. Programs employing a multimodal approach are more effective in improving adherence than programs with informational or behavioral strategies alone. This in turn may improve patient outcomes.
authors: Market Access Solutions, LLC, Raritan, NJ, USA ; University of North Carolina at Charlotte, Charlotte, NC, USA.
authors: Chakkarin
authors: C
authors: Burudpakdee
authors: Celgene Corporation, Summit, NJ, USA.
authors: Zeba M
authors: ZM
authors: Khan
authors: Market Access Solutions, LLC, Raritan, NJ, USA.
authors: Smeet
authors: S
authors: Gala
authors: Market Access Solutions, LLC, Raritan, NJ, USA.
authors: Merena
authors: M
authors: Nanavaty
authors: Celgene Corporation, Summit, NJ, USA.
authors: Satyin
authors: S
authors: Kaura
keywords: behavioral; informational; patient interventions; systematic literature review