Scope of outcomes in trials and observational studies of interventions targeting medication adherence in rheumatic conditions: A systematic review

Ayano Kelly, Luke Crimston-Smith, Allison Tong, Susan J. Bartlett, Charlotte L. Bekker, Robin Christensen, Mary A. de Vera, Maarten de Wit, Vicki Evans, Michael Gill, Lyn March, Karine Manera, Robby Nieuwlaat, Shahrzad Salmasi, Marieke Scholte-Voshaar, Jasvinder A. Singh, Daniel Sumpton, Karine Toupin-April, Peter Tugwell, Bart van den BemtSuzanne Verstappen, Kathleen Tymms

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

Objective. Nonadherence to medications is common in rheumatic conditions and associated with increased morbidity. Heterogeneous outcome reporting by researchers compromises the synthesis of evidence of interventions targeting adherence. We aimed to assess the scope of outcomes in interventional studies of medication adherence. Methods. We searched electronic databases to February 2019 for published randomized controlled trials and observational studies of interventions with the primary outcome of medication adherence including adults with any rheumatic condition, written in English. We extracted and analyzed all outcome domains and adherence measures with prespecified extraction and analysis protocols. Results. Overall, 53 studies reported 71 outcome domains classified into adherence (1 domain), health outcomes (38 domains), and adherence-related factors (e.g., medication knowledge; 32 domains). We subdivided adherence into 3 phases: initiation (n = 13 studies, 25%), implementation (n = 32, 60%), persistence (n = 27, 51%), and phase unclear (n = 20, 38%). Thirty-seven different instruments reported adherence in 115 unique ways (this includes different adherence definitions and calculations, metric, and method of aggregation). Forty-one studies (77%) reported health outcomes. The most frequently reported were medication adverse events (n = 24, 45%), disease activity (n = 11, 21%), bone turnover markers/physical function/ quality of life (each n = 10, 19%). Thirty-three studies (62%) reported adherence-related factors. The most frequently reported were medication beliefs (n = 8, 15%), illness perception/medication satisfaction/satisfaction with medication information (each n = 5, 9%), condition knowledge/medication knowledge/trust in doctor (each n = 3, 6%). Conclusion. The outcome domains and adherence measures in interventional studies targeting adherence are heterogeneous. Consensus on relevant outcomes will improve the comparison of different strategies to support medication adherence in rheumatology.

Original languageEnglish
Pages (from-to)1565-1574
Number of pages10
JournalJournal of Rheumatology
Volume47
Issue number10
DOIs
Publication statusPublished - 1 Oct 2020

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