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17-09-2012 | Article

Reminders, case management get patients to take their medicine


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medwireNews: Nagging usually does not work, but there are several effective interventions for getting patients to take their medicine, a study finds.

"We found evidence of effective interventions to improve medication adherence for many chronic conditions. These analyses suggest that patients' adherence to chronic-disease medications can be improved through programs targeting patients, providers, health systems, or policy. They demonstrated that a broad range of approaches can work," write Meera Viswanathan (RTI International, Durham, North Carolina) and colleagues in a report commissioned by the Agency for Healthcare Research and Quality (AHRQ).

The authors combed through nearly 4000 abstracts to identify 58 trials and four observational studies looking at interventions to improve patient adherence to medication for chronic conditions. Patients in the studies included those with diabetes, hypertension, lipid disorders, cardiovascular disease, asthma, glaucoma, depression, multiple sclerosis, musculoskeletal disease, and other chronic conditions.

They found that irrespective of the condition, the most consistently helpful interventions were those that reduced patients' out-of-pocket expenses or expanded coverage of prescription drugs, as well as case management and educational programs.

"Within clinical conditions, we found the strongest support for self-management of medications for short-term improvement in adherence for asthma patients; collaborative care or case management programs for short-term improvement of adherence and to improve symptoms for patients taking depression medications; and pharmacist-led approaches for hypertensive patients to improve systolic blood pressure," the AHRQ report authors write.

Successful interventions for improving adherence ranged from simple, low-cost telephone and mail reminders, to more labor- and time-intensive options such as case management and care coordination, which often involve close monitoring of patients for an extended period.

"Despite such evidence about promising approaches to improving medication adherence, only a subset of these effective interventions relates better adherence with better health outcomes or other important end results. We found relatively little evidence linking improved adherence to improvements in other outcomes, such as biomarkers, morbidity, mortality, quality of life, quality of care, patient satisfaction, healthcare utilization, and costs," the authors caution.

By Neil Osterweil, medwireNews reporter