Richard E Deichmann1, Michael D Morledge2, Robin Ulep2, Johnathon P Shaffer2, Philippa Davies3, Mieke L van Driel4. 1. Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA. 2. The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA. 3. School of Social and Community Medicine, University of Bristol, Bristol, UK. 4. Discipline of General Practice, School of Medicine, The University of Queensland, Brisbane, Australia.
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). CONCLUSION: 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.
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). CONCLUSION: 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: Robyn Tamblyn; Kristen Reidel; Allen Huang; Laurel Taylor; Nancy Winslade; Gillian Bartlett; Roland Grad; André Jacques; Martin Dawes; Pierre Larochelle; Alain Pinsonneault Journal: Med Decis Making Date: 2009-08-12 Impact factor: 2.583
Authors: Simone R B M Eussen; Marcel L Bouvy; Cathy J M Rompelberg; Menno E van der Elst; Johan Garssen; Marco H Oosterveld; Anthonius de Boer; Johan J de Gier; Henk J van Kranen; Olaf H Klungel Journal: Pharmacoepidemiol Drug Saf Date: 2011-06-07 Impact factor: 2.890
Authors: Niteesh K Choudhry; Jerry Avorn; Robert J Glynn; Elliott M Antman; Sebastian Schneeweiss; Michele Toscano; Lonny Reisman; Joaquim Fernandes; Claire Spettell; Joy L Lee; Raisa Levin; Troyen Brennan; William H Shrank Journal: N Engl J Med Date: 2011-11-14 Impact factor: 91.245
Authors: Alexander Kulik; Nihar R Desai; William H Shrank; Elliott M Antman; Robert J Glynn; Raisa Levin; Lonny Reisman; Troyen Brennan; Niteesh K Choudhry Journal: Circulation Date: 2013-09-10 Impact factor: 29.690
Authors: P Michael Ho; Anne Lambert-Kerzner; Evan P Carey; Ibrahim E Fahdi; Chris L Bryson; S Dee Melnyk; Hayden B Bosworth; Tiffany Radcliff; Ryan Davis; Howard Mun; Jennifer Weaver; Casey Barnett; Anna Barón; Eric J Del Giacco Journal: JAMA Intern Med Date: 2014-02-01 Impact factor: 21.873
Authors: Raymond Kodsi; Ritesh Chimoriya; David Medveczky; Kathy Grudzinskas; Evan Atlantis; Abd A Tahrani; Nic Kormas; Milan K Piya Journal: Nutrients Date: 2022-02-24 Impact factor: 5.717
Authors: David Rott; Ilan Hay; Irene Nabutovsky; Alexis Heller; Daniel Breitner; Robert Klempfner Journal: Int J Cardiol Cardiovasc Risk Prev Date: 2022-08-17