RT Journal Article
SR Electronic
T1 Health system barriers and facilitators to medication adherence for the secondary prevention of cardiovascular disease: a systematic review
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e000438
DO 10.1136/openhrt-2016-000438
VO 3
IS 2
A1 Amitava Banerjee
A1 Shweta Khandelwal
A1 Lavanya Nambiar
A1 Malvika Saxena
A1 Victoria Peck
A1 Mohammed Moniruzzaman
A1 Jose Rocha Faria Neto
A1 Katherine Curi Quinto
A1 Andrew Smyth
A1 Darryl Leong
A1 José Pablo Werba
YR 2016
UL http://openheart.bmj.com/content/3/2/e000438.abstract
AB Background Secondary prevention is cost-effective for cardiovascular disease (CVD), but uptake is suboptimal. Understanding barriers and facilitators to adherence to secondary prevention for CVD at multiple health system levels may inform policy.Objectives To conduct a systematic review of barriers and facilitators to adherence/persistence to secondary CVD prevention medications at health system level.Methods Included studies reported effects of health system level factors on adherence/persistence to secondary prevention medications for CVD (coronary artery or cerebrovascular disease). Studies considered at least one of β blockers, statins, angiotensin–renin system blockers and aspirin. Relevant databases were searched from 1 January 1966 until 1 October 2015. Full texts were screened for inclusion by 2 independent reviewers.Results Of 2246 screened articles, 25 studies were included (12 trials, 11 cohort studies, 1 cross-sectional study and 1 case–control study) with 132 140 individuals overall (smallest n=30, largest n=63 301). 3 studies included upper middle-income countries, 1 included a low middle-income country and 21 (84%) included high-income countries (9 in the USA). Studies concerned established CVD (n=4), cerebrovascular disease (n=7) and coronary heart disease (n=14). Three studies considered persistence and adherence. Quantity and quality of evidence was limited for adherence, persistence and across drug classes. Studies were concerned with governance and delivery (n=19, including 4 trials of fixed-dose combination therapy, FDC), intellectual resources (n=1), human resources (n=1) and health system financing (n=4). Full prescription coverage, reduced copayments, FDC and counselling were facilitators associated with higher adherence.Conclusions High-quality evidence on health system barriers and facilitators to adherence to secondary prevention medications for CVD is lacking, especially for low-income settings. Full prescription coverage, reduced copayments, FDC and counselling may be effective in improving adherence and are priorities for further research.