TY - JOUR
T1 - Scope of outcomes in trials and observational studies of interventions targeting medication adherence in rheumatic conditions
T2 - A systematic review
AU - Kelly, Ayano
AU - Crimston-Smith, Luke
AU - Tong, Allison
AU - Bartlett, Susan J.
AU - Bekker, Charlotte L.
AU - Christensen, Robin
AU - de Vera, Mary A.
AU - de Wit, Maarten
AU - Evans, Vicki
AU - Gill, Michael
AU - March, Lyn
AU - Manera, Karine
AU - Nieuwlaat, Robby
AU - Salmasi, Shahrzad
AU - Scholte-Voshaar, Marieke
AU - Singh, Jasvinder A.
AU - Sumpton, Daniel
AU - Toupin-April, Karine
AU - Tugwell, Peter
AU - van den Bemt, Bart
AU - Verstappen, Suzanne
AU - Tymms, Kathleen
N1 - Funding Information:
The work reported in this manuscript was supported by the 2018 Arthritis Australia Project Grant. AK is supported by the Australian Government Research Training Scholarship. SV is supported by Versus Arthritis (grant number 20385) and NIHR Manchester Biomedical Research Centre. RC (The Parker Institute, Copenhagen University Hospital) is supported by a core grant from the Oak Foundation (OCAY-13-309). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. 1A. Kelly, Clinical Associate Lecturer, Australian National University, MBBS, FRACP, College of Health and Medicine, Australian National University, and Canberra Rheumatology, Canberra, and Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia; 2L. Crimston-Smith, BN, College of Health and Medicine, Australian National University, and Canberra Rheumatology, Canberra, Australia; 3A. Tong, PhD, Professor, K. Manera, MIPH, Centre for Kidney Research, The Children’s Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, Sydney, Australia; 4S.J. Bartlett, PhD, Professor, Department of Medicine, McGill University and Research Institute, McGill
Publisher Copyright:
Copyright © 2020. All rights reserved.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - 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.
AB - 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.
KW - Clinical trials
KW - Medication adherence
KW - Outcome assessment (health care)
KW - Patient compliance
KW - Rheumatic diseases
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85091619031&partnerID=8YFLogxK
U2 - 10.3899/jrheum.190726
DO - 10.3899/jrheum.190726
M3 - Article
C2 - 31839595
AN - SCOPUS:85091619031
VL - 47
SP - 1565
EP - 1574
JO - Journal of Rheumatology
JF - Journal of Rheumatology
SN - 0315-162X
IS - 10
ER -