Evaluating the Effectiveness of Remote Behavioral Interventions Facilitated by Health Care Providers at Improving Medication Adherence in Cardiometabolic Conditions: A Systematic Review and Meta-Analysis

Systematic Review of Outcomes for Assessment of Medication Adherence Enhancing Interventions: An ISPOR Special Interest Group Report

OBJECTIVES

The lack of universal guidance on outcome measures for evaluating medication adherence enhancing interventions (MAEIs) poses a challenge for assessing their effectiveness. This literature review aimed to provide a systematic overview of outcome measures currently used for the value assessment of MAEIs.

METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched MEDLINE, PsycINFO, Scopus, CINAHL, and Academic Search Complete for randomized and nonrandomized clinical trials, prospective cohort studies, model-based economic evaluations, and value frameworks published in English between January 2010 and September 2020. Two independent reviewers screened all titles and abstracts, followed by a full-text review. Due to the large number of relevant studies, data extraction was limited to articles published between January 2018 and September 2020. We collected data on the general characteristics of the study, the type of intervention, and the outcomes measured.

RESULTS

We screened 14 685 records and identified 308 articles for data extraction. Behavioral interventions were the most common (n = 143), followed by educational interventions (n = 110) and mixed-method interventions (n = 73). Outcomes were clustered into 7 categories with medication adherence (n = 286) being the most frequently measured, followed by clinical outcomes (n = 155), health-related quality of life (n = 57), resource use (n = 43), patient satisfaction (n = 31), economic outcomes (n = 18), and other outcomes (n = 76).

CONCLUSIONS

Various outcomes measures have been used to evaluate MAEIs, with only a small number of studies exploring economic and patient-reported outcomes. Future research is warranted to develop a consensus-based set of criteria for assessing MAEIs to facilitate the comparison of interventions and enable informed decision making.

Effectiveness of Remote Interventions to Improve Medication Adherence in Patients after Stroke: A Systematic Literature Review and Meta-Analysis

BACKGROUND

Stroke affects more than 30 million people every year, but only two-thirds of patients comply with prescribed medication, leading to high stroke recurrence rates. Digital technologies can facilitate interventions to support treatment adherence.

PURPOSE

This study evaluates the effectiveness of remote interventions and their mechanisms of action in supporting medication adherence after stroke.

METHODS

PubMed, MEDLINE via Ovid, Cochrane CENTRAL, the Web of Science, SCOPUS, and PsycINFO were searched, and meta-analysis was performed using the Review Manager Tool. Intervention content analysis was conducted based on the COM-B model.

RESULTS

Ten eligible studies were included in the review and meta-analysis. The evidence suggested that patients who received remote interventions had significantly better medication adherence (SMD 0.49, 95% CI [0.04, 0.93], and p = 0.03) compared to those who received the usual care. The adherence ratio also indicated the interventions' effectiveness (odds ratio 1.30, 95% CI [0.55, 3.10], and p = 0.55). The systolic and diastolic blood pressure (MD -3.73 and 95% CI [-5.35, -2.10])/(MD -2.16 and 95% CI [-3.09, -1.22]) and cholesterol levels (MD -0.36 and 95% CI [-0.52, -0.20]) were significantly improved in the intervention group compared to the control. Further behavioural analysis demonstrated that enhancing the capability within the COM-B model had the largest impact in supporting improvements in adherence behaviour and relevant clinical outcomes. Patients' satisfaction and the interventions' usability were both high, suggesting the interventions' acceptability.

CONCLUSION

Telemedicine and mHealth interventions are effective in improving medication adherence and clinical indicators in stroke patients. Future studies could usefully investigate the effectiveness and cost-effectiveness of theory-based and remotely delivered interventions as an adjunct to stroke rehabilitation programmers.