A Systematic Review of Adherence-Enhancing Interventions in Adolescents Taking Long-term Medicines

doi:10.1016/j.jadohealth.2011.02.010

Journal of Adolescent Health

Volume 49, Issue 5, November 2011, Pages 455-466

https://doi.org/10.1016/j.jadohealth.2011.02.010 Get rights and content

Abstract

Purpose

To assess the effectiveness of adherence-enhancing interventions (AEIs) aimed at adolescents (10–19-year-olds).

Methods

An extensive search of seven bibliographic databases was conducted at the end of 2009 to identify comparative studies evaluating AEIs targeting adolescents. Data describing study characteristics and intervention effects on adherence to medicines or health outcomes were extracted and summarized using qualitative and quantitative methods.

Results

A total of 17 AEIs were identified: 12 studies (70%) were conducted in the United States, 10 (59%) included adolescents with type 1 diabetes mellitus, and 14 (82%) considered the developmental tasks of adolescence. In all, 12 AEIs successfully improved outcome measures. Features of successful interventions included targeting AEIs to a narrow age range, including family in type 1 diabetes mellitus management, and improving access to care. Poor quality and underpowered studies limit the inferences drawn from this review.

Conclusions

More diverse and robust studies are needed to identify strategies to help adolescents manage medicines.

Section snippets

Method

A literature search (on research spanning 25 years; 1984–2009) was conducted in November and December 2009 to identify studies for inclusion into the review. Electronic databases searched include the following: EMBASE, MEDLINE, and PsycINFO (all through OVID); CINAHL (through EBSCO host); ISI Web of Knowledge; IPA (through the Royal Pharmaceutical Society of Great Britain information department); and the Cochrane Central Register of Controlled Trials (through the Cochrane Library). References

Studies retrieved

The initial database search produced 22,784 citations from which titles and abstracts were screened for relevance. From this, 66 full articles were obtained for further screening. A further 19 articles were identified through the bibliographies of review and retrieved articles. A total of 20 articles, representing 17 intervention studies, were retained for inclusion into the review (Figure 1).

The main characteristics of studies reviewed have been summarized in Table 1.

Study participants

In all studies, the

Discussion

Systematic and meta-analytic reviews assessing the effectiveness of AEIs have been conducted in the past; however, to our knowledge, this is the first systematic review undertaken to examine the effectiveness of AEIs in improving adherence to medicines exclusively in adolescent patients. Altogether 12 AEIs assessed in this review were effective in improving adherence to medicines and/or health outcomes [38], [41], [42], [43], [46], [48], [49], [50], [51], [52], [53], [54]. The AEIs were

Limitations

The selection of English language articles may have introduced bias. However, there is some evidence in previously published data to suggest that excluding non-English language studies does not affect results obtained in review studies [70]. This review also excluded studies in which adolescents were included in samples containing younger children and adults on the grounds that the intervention was not specifically targeted at adolescents.

The limited geographic, ethnic, and disease diversity

Summary

Adolescence is understood to be a much anticipated and important developmental phase that bridges childhood and adulthood. Findings from this review suggest that to some extent AEIs are effective in improving adherence to medicines and health outcomes in adolescent patients. Targeting a narrow age range, inclusion of family members in the management of T1DM, and improving access to care appeared to be useful ingredients of the AEIs. The generalizability of results from this review may be

Acknowledgments

The authors thank Erin Connelly for commenting on an earlier draft of this manuscript. Everyone who has contributed significantly to the work has been listed. Source of support: Ph.D. funded by the School of Pharmacy, University of Nottingham. The University of Nottingham provided funding for completing a Ph.D. (review undertaken as part of Ph.D. study).

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Review articleA Systematic Review of Adherence-Enhancing Interventions in Adolescents Taking Long-term Medicines

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Method

Studies retrieved

Study participants

Discussion

Limitations

Summary

Acknowledgments

J Allergy Clin Immunol

J Adolesc Health

Control Clin Trials

J Pediatr

Patient Educ Couns

Lancet

Ann Allergy Asthma Immunol

Prescription cost analysis England 2008

Chronic diseases [Online]

Patient adherence and medical treatment outcomes: A meta-analysis

Med Care

Adherence to long-term therapies: Evidence for action

Variations in patients' adherence to medical recommendations: A quantitative review of 50 years of research

Med Care

Medication adherence in pediatric asthma: Reasoning, responsibility, and behavior

J Pediatr Psychol

Chronic illness and disability

Br Med J

Adolescent development

Br Med J

Being different: Adolescents, chronic illness and disability

Noncompliance with medication regimens and subsequent hospitalizations: A literature analysis and cost of hospitalization estimate

J Res Pharm Econ

Adolescent risk factors for excessive alcohol use at age 32 years: A 16-year prospective follow-up study

Soc Psychiatry Psychiatr Epidemiol

Risk-taking behaviour in adolescence: A literature review

J Child Health Care

Parent-adolescent discrepancies in adolescents' competence and the balance of adolescent autonomy and adolescent and parent well-being in the context of type 1 diabetes

Dev Psychol

Strategies to improve compliance with referrals, appointments, and prescribed medical regimens

Effectiveness of interventions to improve patient compliance: A meta-analysis

Med Care

Empirically supported treatments in pediatric psychology: Regimen adherence

J Pediatr Psychol

Meta-analysis of trials of interventions to improve medication adherence

Am J Health Syst Pharm

Concordance, adherence and compliance in medicine-taking

Interventions for enhancing medication adherence

Cochrane Database Syst Rev

Meta-analysis of psychological interventions to promote adherence to treatment in pediatric chronic health conditions

J Pediatr Psychol

The efficacy of adherence interventions for chronically ill children: A meta-analytic review

J Pediatr Psychol

A systematic review of interventions to enhance medication adherence in children and adolescents with chronic illness

Arch Dis Child

Cochrane Airways Group [Online]

Cochrane child health field [Online]

Cochrane handbook for systematic review of interventions 4.2.6 [Online]

Adolescent health [Online]

The Guidelines Manual: Appendices [Online]

Review article
A Systematic Review of Adherence-Enhancing Interventions in Adolescents Taking Long-term Medicines