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Strategies to improve adherence to medications for cardiovascular diseases in socioeconomically disadvantaged populations: A systematic review

Laba, Tracey-Lea, Bleasel, Jonathan, Brien, Jo-anne, Cass, Alan, Howard, Kirsten, Peiris, David, Redfern, Julie, Salam, Abdul, Usherwood, Tim and Jan, Stephen (2013). Strategies to improve adherence to medications for cardiovascular diseases in socioeconomically disadvantaged populations: A systematic review. International Journal of Cardiology,167(6):2430-2440.

Document type: Journal Article

IRMA ID 11035xPUB60
Title Strategies to improve adherence to medications for cardiovascular diseases in socioeconomically disadvantaged populations: A systematic review
Author Laba, Tracey-Lea
Bleasel, Jonathan
Brien, Jo-anne
Cass, Alan
Howard, Kirsten
Peiris, David
Redfern, Julie
Salam, Abdul
Usherwood, Tim
Jan, Stephen
Journal Name International Journal of Cardiology
Publication Date 2013
Volume Number 167
Issue Number 6
ISSN 0167-5273   (check CDU catalogue  open catalogue search in new window)
Start Page 2430
End Page 2440
Total Pages 11
Place of Publication Ireland
Publisher Elsevier Ireland Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract Medication non-adherence poses a major barrier to reducing cardiovascular disease (CVD) burden globally, and is increasingly recognised as a socioeconomically determined problem. Strategies promoting CVD medication adherence appear of moderate effectiveness and cost-effectiveness. Potentially, 'one-size-fits-all' measures are ill-equipped to address heterogeneous adherence behaviour between social groups. This review aims to determine the effects of strategies to improve adherence to CVD-related medications in socioeconomically disadvantaged groups. Randomised/quasi-randomised controlled trials (1996-June 2012, English), testing strategies to increase adherence to CVD-related medications prescribed to adult patients who may experience health inequity (place of residence, occupation, education, or socioeconomic position) were reviewed. 772 abstracts were screened, 111 full-text articles retrieved, and 16 full-text articles reporting on 14 studies, involving 7739 patients (age range 41-66 years), were included. Methodological and clinical heterogeneity precluded quantitative data synthesis. Studies were thematically grouped by targeted outcomes; underlying interventions and policies were classified using Michie et al.'s Behaviour Change Wheel. Contrasting with patient or physician/practice strategies, those simultaneously directed at patients and physicians/practices resulted in statistically significant improvements in relative adherence (16-169%). Comparative cost and cost-effectiveness analyses from three studies did not find cost-saving or cost-effective strategies. Unlike much current evidence in general populations, promising evidence exists about what strategies improve adherence in disadvantaged groups. These strategies were generally complex: simultaneously targeting patients and physicians; addressing social, financial, and treatment-related adherence barriers; and supported by broader guidelines, regulatory and communication-based policies. Given their complexity and potential resource implications, comprehensive process evaluations and cost and cost-effectiveness evidence are urgently needed.
DOI http://dx.doi.org/10.1016/j.ijcard.2013.01.049   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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