Medication Compliance, Adherence, and Persistence: Current Status of Behavioral and Educational Interventions to Improve Outcomes

BACKGROUND: Poor adherence and persistence are serious issues in the management of chronic conditions. A mounting body of evidence indicates that decreased medication adherence is associated with increased hospitalizations and total costs of care. OBJECTIVE: To review the predictors of adherence to and persistence with medications and to discuss the intervention strategies that have been used to address adherence in chronic conditions. SUMMARY: Several intervention strategies have been used to address adherence in chronic conditions. These strategies can be grouped into 3 categories: informational, behavioral, and combined strategies. It has been shown that the quality of this research is poor, with wide variability in study design, outcomes, and duration. CONCLUSIONS: Adherence is a multifaceted issue, affected by both behavioral and system barriers. At present, few intervention studies have attempted to identify patient barriers and match patients to interventions designed to affect the identified barriers. No one model is better than all others, but simplification of medication regimens and multifaceted behavioral interventions have shown promise in some research. Additional research, utilizing better study methods to minimize confounding and larger sample sizes, is needed to determine which interventions are effective. Future programs designed to impact adherence should focus on (a) identifying patient-specific adherence barriers, (b) identifying other adherence issues, (c) tailoring interventions to eliminate or reduce barriers, and (d) providing ongoing social support for patients. Once we become better able to tailor effective interventions to meet patient needs rather than offering the same intervention to all patients, we will begin to achieve better outcomes with greater efficiency. J Manag Care Pharm. 2008;14(6)(suppl S-d):S2-S10 Copyright © 2008, Academy of Managed Care Pharmacy. All rights reserved. DANIEL R. TOUCHETTE, PharmD, MA, is an Assistant Professor of Pharmacy Practice and Core Faculty, Center of Pharmacoeconomic Research, University of Illinois at Chicago; NANCY L. SHAPIRO, PharmD, BCPS, is a clinical pharmacist, Ambulatory Care; director, Ambulatory Care Residency; and clinical assistant professor, Department of Pharmacy Practice, University of Illinois at Chicago. AUTHOR CORRESPONDENCE: Daniel R. Touchette, PharmD, MA, University of Illinois at Chicago, 833 S. Wood St., Chicago, IL 60612. Tel.: 312.355.3204; Fax: 312.996.2954; E-mail: [email protected] Author