Multiprofessional Interventions to Improve Patient Adherence to Cardiovascular Medications

Abstract

Background: Poor adherence to medications is a significant health care issue, particularly among cardiovascular patients. A variety of interventions have been tested by researchers in an effort to identify the most effective approach to improving adherence. Interventions delivered by multiple health care professionals (HCPs) may have an impact on improving adherence to medications in patients with chronic conditions, although the evidence to support this is still limited. Objective: To investigate the impact of interventions delivered by HCPs within a multiprofessional team to improve patients’ adherence to cardiovascular disease medications in community settings. Search strategy: The search strategy involved the use of the following data bases: Google scholar, PubMed, Medline, Cinahl, Embase, IPA, and Cochrane Library, from 1994 to 2010. Search was restricted to articles published in English. Selection criteria: Cluster randomized trials, controlled randomized clinical trials, prospective randomized trials, and nonrandomized studies were included. We considered any intervention designed to enhance adherence to medication directed by more than 1 HCP. Results: We included 17 studies testing 3 different types of interventions directed by more than 1 HCP. The HCPs received a variety of training via educational lectures or interactive workshops. Informational, behavioral, and combined interventions were delivered to cardiovascular patients. The majority of studies using only informational interventions or a combination of behavioral and informational interventions showed improvements in clinical outcomes (ie, blood pressure and total cholesterol lowering). However, only 2 studies measured improvements in adherence but the results were not significant. In contrast, all interventions based on the behavior change strategies improved both clinical outcomes and adherence to medication. Conclusions: Behavioral interventions delivered by a multiprofessional team appear to offer the best opportunity to improve clinical outcomes through improvements in adherence. However, whether interventions delivered by a multiprofessional team are more clinically effective than those delivered by a single HCP remain to be tested.