title: A Metaanalysis of Interventions to Improve Adherence to Lipid-Lowering Medication.
abstract: BACKGROUND
  Inadequate patient adherence to a medication regimen is a major factor in the lack of success in treating hyperlipidemia. Improved adherence rates may result in significantly improved cardiovascular outcomes in populations treated with lipid-lowering therapy. The purpose of this metaanalysis was to evaluate the effectiveness of interventions aimed at improving adherence to lipid-lowering drugs, focusing on measures of adherence and clinical outcomes.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature databases through January 14, 2015, and also used the results from previous Cochrane reviews of this title. Randomized controlled trials of adherence-enhancing interventions for lipid-lowering medication in adults in an ambulatory setting with measurable outcomes were evaluated with criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions.
  
  
  RESULTS
  Twenty-seven studies randomly assigning 899,068 participants to a variety of interventions were analyzed. One group of interventions categorized as intensified patient care showed significant improvement in adherence rates when compared to usual care (odds ratio 1.93; 95% confidence interval [CI] 1.29-2.88). Additionally, after <6 months of follow-up, total cholesterol decreased by a mean of 17.15 mg/dL (95% CI 1.17-33.14), while after >6 months total cholesterol decreased by a mean of 17.57 mg/dL (95% CI 14.95-20.19).
  
  
  CONCLUSIONS
  Healthcare systems that can implement team-based intensified patient care interventions, such as electronic reminders, pharmacist-led interventions, and healthcare professional education of patients, may be successful in improving adherence rates to lipid-lowering medicines.
authors.affiliation: Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Deichmann
authors.affiliation: The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Morledge
authors.affiliation: The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: Robin
authors.initials: R
authors.lastname: Ulep
authors.affiliation: The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: Johnathon P
authors.initials: JP
authors.lastname: Shaffer
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Philippa
authors.initials: P
authors.lastname: Davies
authors.affiliation: Discipline of General Practice, School of Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: Mieke L
authors.initials: ML
authors.lastname: van Driel
keywords: Cholesterol; hyperlipidemias; lipid-regulating agents; medication adherence