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Cardiovascular Disease: Tailored Pharmacy-based Interventions to Improve Medication Adherence

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 48 studies (search period through August 2018).

The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to cardiovascular disease prevention.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 48 studies that measured intervention effects on medication adherence.

Medication Adherence

The systematic review team converted outcomes from 27 studies into adherent or non-adherent, based on whether patients possessed, took, or refilled their cardiovascular disease prevention medications at least 80% of the time.

  • The proportion of patients considered adherent increased by a median of 6.9 percentage points (an increase of ≈ 9.9%)

The remaining 21 studies used various tools to measure adherence (e.g., objective provider counts or records, self-report) and reported generally favorable results.

Cardiovascular Disease Risk Conditions

A subset of 17 studies evaluated intervention effects on blood pressure control and lipid control.

  • There was a median increase of 13.9 percentage points in the proportion of patients who achieved blood pressure control (13 studies)
    • This represents a relative increase of ≈ 35.3% (12 studies)
  • Results were mixed for LDL (3 studies) and cholesterol (1 study).

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

Based on results from the review, the finding should be applicable to patients with cardiovascular disease risk factors who receive medications from community or health system pharmacies.

Evidence Gaps

Additional research and evaluation are needed to answer the following questions and fill existing gaps in the evidence base.

  • How does intervention effectiveness vary with different intervention components? Are interventions more effective when tailored options include system-level approaches, such as refill synchronization or blister packaging?
  • Within a tailored approach, are some adherence barriers commonly addressed by specific intervention options? Does evidence indicate that some adherence barriers can be removed with a specific component, allowing for some standardization in tailored interventions?
  • How effective are tailored interventions when targeted to specific patients at risk for adherence barriers, such as patients with low income or low health-literacy?
  • How effective are tailored interventions when implemented in pharmacies that serve minority and low-income communities?
  • How effective are tailored interventions that engage community health workers and pharmacy technicians in appropriate assessment, coaching, or follow-up roles?

Study Characteristics

  • Included studies were conducted in the United States (23 studies), Europe (12 studies), Canada (5 studies), Hong Kong (4 studies), and Australia (4 studies).
  • Studies were implemented in community pharmacies (27 studies), health system pharmacies (14 studies), or a combination of both (5 studies). Across all studies, the median age for patients was 61.6 years (43 studies), and 52.1% were female (46 studies).
  • Of the 48 included studies, 26 were randomized controlled trials, seven were other design with concurrent comparison, one was before and after with comparison, six used a retrospective cohort, and eight were before and after without a comparison.