Influence of medication regimen complexity on adherence: a systematic review
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Universidade Federal de Minas Gerais
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Background: Having a high medication regimen
complexity has been negatively associated to health
outcomes, such as hospitalizations and poor quality
of life. However, its influence on adherence has not
been well established.
Objectives: To systematically review and summarize
the evidence regarding the association between medication regimen complexity and adherence in any
pharmacotherapy.
Methods: Articles were searched using MEDLINE,
LILACS, Cochrane, CINAHL, PsycINFO and included studies references. Search terms included medication regimen complexity and medication adherence.
Randomized clinical trials, cross-sectional, cohort or
case-control studies published before March 2016 in
English, Portuguese or Spanish languages were eligible if quantitatively examined the correlation between
medication regimen complexity and medication adherence in patients of any age and sex, under any type of
medication therapy. All type of instruments used to assess complexity and adherence were considered. Quality assessment was conducted independently using
standard scales according of the study design.
Results: Fifty-four studies met the inclusion criteria:
37 cross-sectional and 17 cohort studies. Most of them
(51) were conducted in outpatient setting. Most frequently, the studies were carried out with HIV-infected individuals (10) or patients with chronic
conditions: diabetes mellitus (7), epilepsy (3) and hypertension (2). Forty-two studies used only one
method to assess complexity, the most frequent ones
were a complexity index (18 studies), such as Medication Regimen Complexity Index and Antiretroviral
Regimen Complexity Index, and the number of medications (13 studies). Among the instruments used to
measure adherence, the most frequent was self-report
(29). Regimen complexity was associated with medication adherence in 36 studies. Most of them (29 studies) identified that participants with more complex
regimens were less likely to adhere to medication therapy; seven studies found a direct correlation, so that
more complex regimens where related with higher adherence. The other studies found inconclusive results or no correlation between complexity and
adherence.
Conclusions: Although there was variability in studies’ conclusions regarding the correlation between
medication regimen complexity and medication adherence, most of them showed a low to moderate-quality
evidence that, regardless the type of pharmacotherapy,
an increased regimen complexity reduces the probability of medication adherence.
Abstract
Assunto
Medicamentos, Adesão à medicação, Complexidade do regime terapêutico
Palavras-chave
Medicamentos, Revisão Sistemática, Complexidade do regime terapêutico, Adesão à medicação
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Endereço externo
https://onlinelibrary.wiley.com/doi/full/10.1002/pds.4275