Medication Adherence

BackgroundMedication adherence is essential for achieving favorable health outcomes, particularly in older adults with multiple chronic conditions.ObjectiveThis systematic review critically appraised current evidence on interventions aimed at enhancing medication adherence in older adults.MethodsLiterature searches were performed in PubMed/MedLine, EMBASE, and Web of Science for articles published up to December 31, 2024. We identified peer-reviewed studies assessing interventions to improve medication adherence in older adults (≥ 60 years). The primary outcome was intervention effectiveness; secondary outcomes were clinical parameters, disease control, health-related quality of life, rehospitalization rates, event rates, mortality rates, feasibility, acceptability or satisfaction levels, and overall costs or cost-effectiveness.ResultsA total of 128 studies was included: 96 randomized controlled trials (RCTs), 16 pre-post studies, 9 non-RCTs, and 7 longitudinal evaluations. The majority (51.2%) was implemented in primary care. An educational component was present in 56.3% of interventions, a technical component in 47.6%, and an attitudinal component in 32.0%. Only 3.2% of interventions included rewards. Various healthcare professionals, such as pharmacists, nurses, and physicians, were involved in delivering interventions. Most studies reported improved adherence, though some factors, such as high baseline adherence, insufficient intervention intensity, and brief follow-up limited the effectiveness. Secondary outcomes often included improvements in disease knowledge, patient satisfaction, quality of life, and clinical indicators like blood pressure and HbA1c levels.ConclusionsDespite most studies showed a positive impact on adherence, a high heterogeneity was highlighted, and effectiveness was mainly observed in the short term.

ObjectivesPoor adherence to psychopharmacological treatment may contribute to relapses in bipolar disorder (BD). We performed a systematic review and meta-analysis to identify factors associated with poor adherence in BD.MethodsThe protocol was registered in Open Science Framework Registries (https://doi.org/10.17605/OSF.IO/2KZFJ). We searched main electronic databases through March 2025. Random-effects meta-analyses were performed to obtain pooled odds ratios (ORs) and standardized mean differences (SMDs) for relevant correlates.ResultsWe included 19 studies. Subjects with poor adherence were more likely to be younger (SMD = -0.22, 95% CI: -0.42--0.02) and to have lower education (SMD = -0.34, 95% CI: -0.55--0.12), and less likely to be in a relationship (OR = 0.54, 95% CI: 0.34-0.86). Moreover, earlier age at onset (SMD = -0.29, 95% CI: -0.53--0.04), psychotic features (OR = 1.58, 95% CI: 1.30-1.92), a history of suicide attempts (OR = 1.36, 95% CI: 1.03-1.78), a higher number of manic (SMD = 0.34, 95% CI: 0.08-0.61) and mixed (SMD = 0.16, 95% CI: 0.03-0.28) episodes, and more hospitalizations (SMD = 0.53, 95% CI: 0.32-0.73) all emerged as correlates of poor adherence. Also, cannabis (OR = 2.34, 95% CI: 1.79-3.07) and alcohol use disorders (OR = 1.71, 95% CI: 1.39-2.12), comorbid generalized anxiety disorder (OR = 3.70, 95% CI: 1.90-7.22), and comorbid personality disorders (OR = 5.54, 95% CI: 1.32-23.15) were associated with poor adherence. Finally, poorly adherent individuals had higher global severity (SMD = 0.21, 95% CI: 0.01-0.41), lower insight (SMD = -0.74, 95% CI: -1.08--0.41), and lower global functioning (SMD = -0.60, 95% CI: -0.87--0.34). No differences were estimated for other variables.ConclusionsThis meta-analysis showed that poor adherence in people with BD is associated with specific correlates. Although evidence was generally weak due to small effect sizes, imprecision, inconsistency, and potential publication bias, our findings highlight the importance of strategies to improve adherence.

ObjectiveLow-dose aspirin is proven to reduce the incidence of pre-eclampsia, yet adherence remains low. This systematic review synthesises qualitative evidence on barriers and facilitators to low-dose aspirin adherence in pregnancy and uses a co-production approach to develop an explanatory model of this complex behaviour. The overall aim is to contribute to the development of a theory of adherence, targeting this health issue.MethodsData sources: A search of electronic databases (Medline, Web of Science, CINAHL, PsycINFO, Embase, Scopus, Open Grey, Google Scholar, Prospero), charity and professional organisations' archives was conducted using predefined terms. Citation searching was also performed. Searches were not time-limited or language-specific and completed in November 2024.Eligibility criteriaStudies, which included qualitative data on low-dose aspirin determinants of adherence in pregnancy were included.Study appraisal and synthesis methodsQuality was assessed using the Critical Appraisal Skills Programme checklist. A meta-ethnography approach with reciprocal translation and line-of-argument synthesis was used. The co-production approach was utilised to streamline future intervention development by engaging key stakeholders in evidence synthesis, enabling them to translate evidence into action, support implementation and overcome the subjectivity inherent in meta-ethnography. Co-production activities followed the nominal group technique and structured discussions.ResultsOut of 3757 items identified through systematic searches of published studies and grey literature, six studies were included in the review. No studies were excluded based on quality. Four 3rd-order constructs with a total of 10 sub-themes were identified: informational gap, verbal and non-verbal health system communication, personal assets and autonomous control. In an explanatory model, we demonstrate that women are advised to take low-dose aspirin in a context of lack of information and misconceptions (informational gap) with patchy and inconsistent messages from the health care system. Women ultimately control their decision about the use of low-dose aspirin, however, the arrival at a decision depends on the utilisation of individual assets (unique personal or social characteristics inherited or acquired).ConclusionsImproving the quality and delivery of information for women and their support networks can reduce the strain on personal resources and make this essential preventive treatment more accessible and equitable.Patient or public contributionA group consisting of representatives from two national charities and a service user worked alongside an academic team, contributing to all aspects of this work, including formulating the research question, participating in the selection of the search terms, conducting screening of the abstracts, data extraction, quality assessment, synthesis, drafting a graphic representation and this manuscript.