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Special Report: Interventions to Improve Patient Adherence with Medications for Chronic Cardiovascular Disorders
Technology Evaluation Center Assessment Program
Volume 18, No. 12
November 2003
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This web page contains the Executive Summary to the Special Report: Interventions to Improve Patient Adherence with Medications for Chronic Cardiovascular Disorders¹
and the link for downloading the full report in PDF format: Full Report Download

The Findings

The Report is a review of reviews of the apposite literature. After eliminating reviews that did not meet TEC’s evidence-based criteria, the authors of the Report include seven systematic reviews, which themselves analyze a total of 69 primary studies pertinent to compliance with cardiovascular medications.

Despite the comprehensiveness of the initial survey of the literature and the extensive database of studies finally considered, little support is demonstrated for the wide range of compliance enhancements that are examined.

The single exception to this disheartening trend is the Report’s finding that simplifying medication dosage schedules has demonstrable value in improving medication adherence.

Otherwise, however, the evidence for compliance enhancement interventions is inadequate to draw conclusions or, less frequently, indicates that an intervention is ineffective.

It appears that, in general, single-strategy, standalone behavioral interventions cannot be expected to produce a significant positive effect.

Complex interventions are found more promising, but, as the Summary points out, “… many of the complex interventions are resource intensive, and may not be easily replicated or implemented in today’s environment. … Furthermore, it is not possible to determine which specific components of these complex strategies resulted in benefit, thus making it difficult to design pragmatic interventions.”

Finally, the Summary notes that the quality of most of the primary studies is, euphemistically put, problematic. Many potential interventions, for example have not been adequately tested. Of special concern is the lack of comparisons of different interventions.

Commentary

While this report deals with medication compliance and chronic cardiovascular disorders, it reflects the lamentable state of affairs of patient compliance throughout healthcare.

Footnotes

1. The report was produced by the Technology Evaluation Center (TEC), an agency founded by the Blue Cross and Blue Shield Association for the purpose of producing “evidence-based technology assessments … of the clinical effectiveness and appropriateness of a given medical procedure, device or drug.” TEC, according to the website, “serves a wide range of clients in both the private and public sectors, including Kaiser Permanente and the Centers for Medicare and Medicaid Services (CMS).”↩