title: Adherence to cardiovascular medications in the South Asian population: A systematic review of current evidence and future directions.
abstract: OBJECTIVE
  To review methods of assessing adherence and strategies to improve adherence to cardiovascular disease (CVD) medications, among South Asian CVD patients.
  
  
  METHODS
  We conducted a systematic review of English language studies that examined CVD medication adherence in South Asian populations from 1966 to April 1, 2015 in SCOPUS and PubMed. Working in duplicate, we identified 61 studies. After exclusions, 26 studies were selected for full text review. Of these, 17 studies were included in the final review. We abstracted data on several factors including study design, study population, method of assessing adherence and adherence rate.
  
  
  RESULTS
  These studies were conducted in India (n = 11), Pakistan (n = 3), Bangladesh (n = 1), Nepal (n = 1) and Sri Lanka (n = 1). Adherence rates ranged from 32%-95% across studies. Of the 17 total publications included, 10 focused on assessing adherence to CVD medications and 7 focused on assessing the impact of interventions on medication adherence. The validated Morisky Medication Adherence Scale (MMAS) was used as the primary method of assessing adherence in five studies. Three studies used validated questionnaires similar to the MMAS, and one study utilized Medication Event Monitoring System caps, with the remainder of the studies utilizing pill count and self-report measures. As expected, studies using non-validated self-report measures described higher rates of adherence than studies using validated scale measurements and pill count. The included intervention studies examined the use of polypill therapy, provider education and patient counseling to improve medication adherence.
  
  
  CONCLUSIONS
  The overall medication adherence rates were low in the region, which suggest a growing need for future interventions to improve adherence.
authors.affiliation: Julia M Akeroyd, Winston J Chan, Salim S Virani, the Health Policy, Quality and Informatics Program, Michael E DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center for Innovations, Houston, TX 77030, United States.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Akeroyd
authors.affiliation: Julia M Akeroyd, Winston J Chan, Salim S Virani, the Health Policy, Quality and Informatics Program, Michael E DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center for Innovations, Houston, TX 77030, United States.
authors.forename: Winston J
authors.initials: WJ
authors.lastname: Chan
authors.affiliation: Julia M Akeroyd, Winston J Chan, Salim S Virani, the Health Policy, Quality and Informatics Program, Michael E DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center for Innovations, Houston, TX 77030, United States.
authors.forename: Ayeesha K
authors.initials: AK
authors.lastname: Kamal
authors.affiliation: Julia M Akeroyd, Winston J Chan, Salim S Virani, the Health Policy, Quality and Informatics Program, Michael E DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center for Innovations, Houston, TX 77030, United States.
authors.forename: Latha
authors.initials: L
authors.lastname: Palaniappan
authors.affiliation: Julia M Akeroyd, Winston J Chan, Salim S Virani, the Health Policy, Quality and Informatics Program, Michael E DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center for Innovations, Houston, TX 77030, United States.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
keywords: Assessing medication adherence; Cardiovascular disease medication; South Asia