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Congruence between patient characteristics and interventions may partly explain medication adherence intervention effectiveness: an analysis of 190 randomized controlled trials from a Cochrane systematic review
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift)
 
ID 3935830
Author(s) Allemann, Samuel S.; Nieuwlaat, Robby; Navarro, Tamara; Haynes, Brian; Hersbergera, Kurt E.; Arnet, Isabelle
Author(s) at UniBasel Arnet, Isabelle
Allemann, Samuel
Hersberger, Kurt
Year 2017
Title Congruence between patient characteristics and interventions may partly explain medication adherence intervention effectiveness: an analysis of 190 randomized controlled trials from a Cochrane systematic review
Journal Journal of Clinical Epidemiology
Volume 91
Number Databases, Factual; Humans; Medication Adherence, psychology; Patient Selection; Randomized Controlled Trials as Topic, methods; Self Administration
Pages / Article-Number 70-79
Keywords patient adherence; meta-analysis; research methods; randomized 61 controlled trials
Mesh terms Databases, Factual; Humans; Medication Adherence, psychology; Patient Selection; Randomized Controlled Trials as Topic, methods; Self Administration
Abstract Due to the negative outcomes of medication nonadherence, interventions to improve adherence have been the focus of countless studies. The congruence between adherence-related patient characteristics and interventions may partly explain the variability of effectiveness in medication adherence studies. In their latest update of a Cochrane review reporting inconsistent effects of adherence interventions, the authors offered access to their database for subanalysis. We aimed to use this database to assess congruence between adherence-related patient characteristics and interventions and its association with intervention effects.; We developed a congruence score consisting of six features related to inclusion criteria, patient characteristics at baseline, and intervention design. Two independent raters extracted and scored items from the 190 studies available in the Cochrane database. We correlated overall congruence score and individual features with intervention effects regarding adherence and clinical outcomes using Kruskal-Wallis rank sum test and Fisher's exact test.; Interrater reliability for newly extracted data was almost perfect with a Cohen's Kappa of 0.92 [95% confidence interval (CI)†=†0.89-0.94; P†<†0.001]. Although present in only six studies, the inclusion of nonadherent patients was the single feature significantly associated with effective adherence interventions (P†=†0.003). Moreover, effective adherence interventions were significantly associated with improved clinical outcomes (odds ratio†=†6.0; 95% CI†=†3.1-12.0; P†<†0.0001). However, neither the overall congruence score nor any other individual feature (i.e., "determinants of nonadherence as inclusion criteria," "tailoring of interventions to the inclusion criteria," "reasons for nonadherence assessed at baseline," "adjustment of intervention to individual patient needs," and "theory-based interventions") was significantly associated with intervention effects.; The presence of only six studies that included nonadherent patients and the interdependency of this feature with the remaining five might preclude a conclusive assessment of congruence between patient characteristics and adherence interventions. In order to obtain clinical benefits from effective adherence interventions, we encourage researchers to focus on the inclusion of nonadherent patients.
Publisher Elsevier
ISSN/ISBN 0895-4356
edoc-URL http://edoc.unibas.ch/58807/
Full Text on edoc No
Digital Object Identifier DOI 10.1016/j.jclinepi.2017.07.011
PubMed ID http://www.ncbi.nlm.nih.gov/pubmed/28802672
ISI-Number WOS:000417550400011
Document type (ISI) Journal Article, Review
 
   

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17/04/2024