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Review
Healthcare provider-led interventions to support medication adherence following ACS: a meta-analysis
  1. Jacob Crawshaw1,
  2. Vivian Auyeung1,
  3. Lucy Ashworth2,
  4. Sam Norton3 and
  5. John Weinman1
  1. 1 Institute of Pharmaceutical Science, King’s College London, London, UK
  2. 2 School of Health Sciences, City University of London, London, UK
  3. 3 Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
  1. Correspondence to Jacob Crawshaw; jacob.crawshaw{at}kcl.ac.uk

Abstract

We conducted a systematic review and meta-analysis to determine the effectiveness of healthcare provider-led (HCPs) interventions to support medication adherence in patients with acute coronary syndrome (ACS). A systematic search of Cochrane Library, Medline, EMBASE, PsycINFO, Web of Science, IPA, CINAHL, ASSIA, OpenGrey, EthOS, WorldCat and PQDT was undertaken. Interventions were deemed eligible if they included adult ACS patients, were HCP-led, measured medication adherence and randomised participants to parallel groups. Intervention content was coded using the Behaviour Change Technique (BCT) Taxonomy and data were pooled for analysis using random-effects models. Our search identified 8870 records, of which 27 were eligible (23 primary studies). A meta-analysis (n=9735) revealed HCP-led interventions increased the odds of medication adherence by 54% compared to control interventions (k=23, OR 1.54, 95% CI 1.26 to 1.88, I2=57.5%). After removing outliers, there was a 41% increase in the odds of medication adherence with moderate heterogeneity (k=21, OR 1.41, 95% CI 1.21 to 1.65, I2=35.3%). Interventions that included phone contact yielded (k=12, OR 1.63, 95% CI 1.25 to 2.12, I2=32.0%) a larger effect compared to those delivered exclusively in person. A total of 32/93 BCTs were identified across interventions (mean=4.7, SD=2.2) with ‘information about health consequences’ (BCT 5.1) (19/23) the most common. HCP-led interventions for ACS patients appear to have a small positive impact on medication adherence. While we were able to identify BCTs among interventions, data were insufficient to determine the impact of particular BCTs on study effectiveness.

PROSPERO registration number CRD42016037706.

  • acute coronary syndrome
  • medication adherence
  • meta-analysis
  • systematic review

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2017-000685

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    Footnotes

    • Contributors Concept design was undertaken by JC, VA and JW. JC undertook the literature search with VA and JW involved in eligibility screening. LA and SN contributed to behaviour change technique coding and statistical analyses, respectively. JC wrote the first draft, with all authors contributing to the critical revision of the manuscript.

    • Funding The authors report that this study was supported by a King’s College London-University of California, San Francisco PhD Studentship (for JC).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.