Controlled studies with at least 60 patients in each group that focused on community-living elderly patients and assessed interventions to improve medication adherence were eligible for inclusion. Patients were aged at least 55 years of age (mean or median age of at least 65 years) and received at least three (or mean/median of four or more) long-term medications. Interventions that sought to increase medication adherence were delivered to the patient or their carer. Control groups could comprise either no intervention or usual care. Patients had to be followed for at least four weeks after the intervention. Adherence to all oral, long-term, solid-dose medications were measured at baseline and study conclusion.
Included studies used educational (verbal or written information) or behavioural (dose administration aid, special medication packaging or labelling, reminder chart or calendar, home visit, follow-up or regimen simplification) interventions or medication review. All studies tested the role of patient education in combination with behavioural strategies and/or provider-focused strategies such medication review. None of the studies assessed a single adherence-enhancing intervention. Interventions were delivered by hospital, community or primary care pharmacists (or a combination). Adherence was measured using self-reported medication utilisation, Morisky scale and its modifications, refill date, prescription claims data and pill count. Relative changes in adherence were estimated from the difference in mean adherence at the conclusion of the study and baseline divided by the baseline adherence. Mean age ranged from 68 to 84 years. The proportion of females was zero to 83%. Studies were conducted in Canada, USA, Australia, UK and one study in seven European countries.
Two reviewers independently selected studies for inclusion in the review. Disagreements were resolved through review by a third reviewer and consensus between all reviewers.