medication adherence interventions and outcomes: an overview of systematic reviews - light measurement tool

Objective to provide evidence for health care
Provide drug adherence interventions for patient clinical, economic and humanistic outcomes.
Methods systematic evaluation of literature research was used in Medline, Embase and CINAHL (2007–2017)
, Use measurement tools to evaluate the quality verification of the system review (AMSTAR)
2 and preferred reporting items for systematic review and Meta-
Analyze the questionnaire and finally extract, combine and list the results of the included studies.
From the AMSTAR 2 score to the 8 systematic reviews of high scores, 37 randomized controlled studies involving 28 600 participants were extracted.
Patient Education and Counseling have some positive effects on compliance with medication.
Patient education has also had some positive effects on morbidity, healthcare facilities and patient satisfaction.
Consultation has some benefits for mortality and health care utilization.
Simplifying the dose has certain benefits for morbidity and patient satisfaction.
Interventions provided by pharmacists and nurses showed better results in improving compliance and outcomes compared to interventions provided by general practitioners.
Conclusions some interventions were found to have a positive impact on adherence and outcomes, but in all cases there was no single strategy to show improvement.
For future studies, non-patients should be screened
If neither is true, stick to revealing them.
Non-adhesion and type
Adhesion, as well as larger sample size and longer follow timeup.
Purpose to provide evidence for health care
Provide drug adherence interventions for patient clinical, economic and humanistic outcomes.
Methods systematic evaluation of literature research was used in Medline, Embase and CINAHL (2007–2017)
, Use measurement tools to evaluate the quality verification of the system review (AMSTAR)
2 and preferred reporting items for systematic review and Meta-
Analyze the questionnaire and finally extract, combine and list the results of the included studies.
From the AMSTAR 2 score to the 8 systematic reviews of high scores, 37 randomized controlled studies involving 28 600 participants were extracted.
Patient Education and Counseling have some positive effects on compliance with medication.
Patient education has also had some positive effects on morbidity, healthcare facilities and patient satisfaction.
Consultation has some benefits for mortality and health care utilization.
Simplifying the dose has certain benefits for morbidity and patient satisfaction.
Interventions provided by pharmacists and nurses showed better results in improving compliance and outcomes compared to interventions provided by general practitioners.
Conclusions some interventions were found to have a positive impact on adherence and outcomes, but in all cases there was no single strategy to show improvement.
For future studies, non-patients should be screened
If neither is true, stick to revealing them.
Non-adhesion and type
Adhesion, as well as larger sample size and longer follow timeup.
Introduction every new drug treatment method implemented in health care must prove effective, both in terms of cost and clinical effect.
It prefers to use the most effective interventions to provide maximum benefit at the lowest cost.
The provision of good health care services depends on the use of existing knowledge and experience, as well as the use of new knowledge at the same time as outdated practices cease.
In addition, there should be a local, regional or national agreement on what is considered good or preferred service performance.
System Review is one of the key tools to obtain evidence
Based on the health care of providers and health care decision makers, a systematic review should therefore provide accurate and best available evidence on topics of interest.
A systematic review of several randomized trials is considered a "gold standard" and provides the highest level of evidence.
3 healthcare providers are responsible for choosing the right treatment method for each patient, which requires professional skills to search, evaluate and use evidence
Basic information in clinical practice.
This method is called evidence.
Based on medicine, this means that the provision of health care is high
High quality evidence, which does more harm than good, provides the greatest benefit to patients.
Drug therapy is important in protecting, maintaining and restoring people's health, so it has an important priority in the resources used in health care.
Because drugs are critical to preventing and treating diseases, we have to ask what happens when the drug is not taken properly, that is, when compliance is low.
The definition of persistence is: "To what extent the patient's behavior is consistent with the agreed advice of the prescription.
WHO said in 2003, insist on long-term
Long-term treatment is as low as 50% in the general population, at low/medium-
Income country.
A Cochrane review points out that people who prescribe for themselves
Administration took only half of their prescribed dose, and many people completely stopped taking the drug without informing their provider.
Many patients who continue to take the drug do not continue to take the drug as required.
There are more and more self-
Drug treatment can be provided, which makes better compliance more important.
Adherence to medication is an important part of health outcomes, so we can also improve patient outcomes by improving medication adherence.
Even the most carefully selected and ideal drug will become ineffective because of not enough persistence.
Failure to adhere to medication can lead to serious deterioration of the disease, death and increased medical costs.
In other words
Persistence has an impact on both individual patients and the health care system.
9 12 studies showed that patients with good adherence to treatment had lower mortality13-15 rates and lower inpatient rates compared to those with poor adherence to treatment.
Who noted that "improving the effectiveness of compliance with interventions may have a far greater impact on population health than any improvement in specific medical treatments.
9 The theoretical framework for donabedian to assess the quality of care consists of three methods: structure, process and outcome.
The structure represents the conditions for providing care, the process represents the activity that constitutes health care, and the result represents a change in the state of health.
It was suggested that good results are the result of the structure that promotes good processes, 19 and that any effort to improve the triad approach must be viewed in light of the patient's care and needs.
In the ECHO model, the results of health care are classified according to the three general dimensions of clinical, economic and humanistic.
The assertion of this study is that this structure is represented by educated and skilled healthcare professionals.
This process represents what the patient does.
Professional interaction in health care (
For example, interventions to improve drug compliance)
The result is a clinical, humanistic and economic result measured by adherence to intervention.
In this context, the purpose of this study is to provide evidence for health care
Provide drug adherence interventions for patient clinical, economic and humanistic outcomes.
Methods literature search after the initial search, in addition to the terms found through the controlled vocabulary in the database, the search strategy is constructed using the relevant text words and their synonyms and opposite words: MeSH (in Medline), Emtree (in Embase)
And CINAHL theme title (in CINAHL).
The final search (
Performance in December 22, 2017)
Limited to the year of publication (2007–2017)
Comments in English and system.
A detailed description of the search is given in Appendix 1 of the online supplement.
The Cochrane Library itself was not searched.
Relevant articles found in the initial search are cross-checked to ensure that they are also included in the final search strategy.
Articles are screened as inclusion and exclusion criteria for titles and summaries.
A full-text evaluation of articles whose title and summary are not excluded is made.
The purpose of literature retrieval is to find a systematic review that meets the inclusion criteria.
If all studies in the systematic review do not match, individual studies in the systematic review are extracted.
References for system reviews selected for quality assessment were also screened.
Supplementary information [ejhpharm-2018-001725supp001. pdf]
The studies included in the inclusion criteria are a systematic review that contains drug adherence interventions, as well as one or more predefined results (
Mortality, incidence, health care utilization, cost of health care and patient satisfaction/quality of life).
A systematic review must include at least two randomized controlled trials (RCT)
Compliance with inclusion criteria
The randomized controlled trials extracted from the systematic review must have a sample size of at least 60 participants in each group in order to detect absolute differences.
Finally, the quality of the methods for these studies must be evaluated in a medium or high degree.
Exclusion criteria system assessment only reports drug compliance, exclusion of alternative endpoints, and exclusion of predefined hard endpoints.
The study must describe the drug adherence intervention, not just the outcome of the intervention.
Interventions are very complex, and there are multiple components of research not only in terms of drug compliance (
For example, diet, exercise, etc)were excluded.
The study was also excluded if not all participants used the drug.
Cochrane reviews for several mixed ingredients, including not only medication compliance, are excluded if the evidence they report is low or very low (
Recommended grading for evaluation, development and evaluation)
The authors believe that even if they score very high on the measurement tools reviewed by the evaluation system (AMSTAR)
2 and preferred reporting items for systematic review and Meta-Analyses (PRISMA).
Research Quality assessment prisma and AMSTAR 2 are effective tools for evaluating the quality of the system.
Guided by 32 systematic evaluations, they were used.
Ten of them were also evaluated by corelsearcher for validation.
The PRISMA checklist is used to evaluate the reporting features, that is, the reporting quality, and the AMSTAR 2 checklist is used to evaluate the methodological quality of the system review.
For the research to be included, the quality of the method has received the highest attention, only the middle to high quality research is included.
PRISMA is a 27-item checklist.
The authors use the PRISMA statement to ensure a clear, complete and transparent system review.
22 The checklist contains seven sections/topics related to the relevant questions.
These answers are very strict with where they are found in the system review, which means that due to the checklist they must be found where they should be.
The answer "yes" is expressed as finding the page number, figure, or table of the item.
"No" or "not applicable" is expressed as a token.
When summed up, all the "yes" got 1 point, making the potential total score 27 points.
AMSTAR, published in boomerang, is widely used to evaluate the quality of methods reviews25-27 by Cochrane and non-Cochrane systems.
Cochrane overview of medical intervention.
28 AMSTAR was recently updated to AMSTAR 2 and is now up to 16-
Project online tools for evaluating high, medium, low, or extremely low system reviews of method quality.
24. Although AMSTAR 2 was not intended to produce an overall score, it was used for the purposes of this report to find the highest quality systematic review.
Based on the original AMSTAR tool, in order to rank system reviews as critical low (0–4u2009p), low (5–8), moderate (9–11)and high (12–16).
Two researchers evaluated the study separately.
Any disagreement was resolved through discussion to reach a consensus on the final score.
Summary evidence is based on the data provided in a systematic review of each included randomized controlled trial.
From the included systematic review only, individual randomized controlled trials were not evaluated and evaluated by major sources.
Evidence of the intervention was explained based on the p-values of CIs and randomized controlled trials reported in the systematic review.
The study was evaluated based on static significant results of predefined results.
"No effect" cut for risk ratio, relative risk, or risk difference and relative interest rate
The Off is set to 1, which means that if CIs crosses 1, the explanation is that the result is not statistically significant.
"No impact" cut for absolute risk and average difference-
Off is set to 0, which means that if 0 is within the CI of the result, the explanation is statistically meaningless.
29 literature search after the initial search, in addition to the terms found in the database through controlled vocabulary, a search strategy was constructed using relevant text words and their synonyms and opposing words: MeSH (in Medline), Emtree (in Embase)
And CINAHL theme title (in CINAHL).
The final search (
Performance in December 22, 2017)
Limited to the year of publication (2007–2017)
Comments in English and system.
A detailed description of the search is given in Appendix 1 of the online supplement.
The Cochrane Library itself was not searched.
Relevant articles found in the initial search are cross-checked to ensure that they are also included in the final search strategy.
Articles are screened as inclusion and exclusion criteria for titles and summaries.
A full-text evaluation of articles whose title and summary are not excluded is made.
The purpose of literature retrieval is to find a systematic review that meets the inclusion criteria.
If all studies in the systematic review do not match, individual studies in the systematic review are extracted.
References for system reviews selected for quality assessment were also screened.
Supplementary information [ejhpharm-2018-001725supp001. pdf]
The studies included in the inclusion criteria are a systematic review that contains drug adherence interventions, as well as one or more predefined results (
Mortality, incidence, health care utilization, cost of health care and patient satisfaction/quality of life).
A systematic review must include at least two randomized controlled trials (RCT)
Compliance with inclusion criteria
The randomized controlled trials extracted from the systematic review must have a sample size of at least 60 participants in each group in order to detect absolute differences.
Finally, the quality of the methods for these studies must be evaluated in a medium or high degree.
Exclusion criteria system assessment only reports drug compliance, exclusion of alternative endpoints, and exclusion of predefined hard endpoints.
The study must describe the drug adherence intervention, not just the outcome of the intervention.
Interventions are very complex, and there are multiple components of research not only in terms of drug compliance (
For example, diet, exercise, etc)were excluded.
The study was also excluded if not all participants used the drug.
Cochrane reviews for several mixed ingredients, including not only medication compliance, are excluded if the evidence they report is low or very low (
Recommended grading for evaluation, development and evaluation)
The authors believe that even if they score very high on the measurement tools reviewed by the evaluation system (AMSTAR)
2 and preferred reporting items for systematic review and Meta-Analyses (PRISMA).
Research Quality assessment prisma and AMSTAR 2 are effective tools for evaluating the quality of the system.
Guided by 32 systematic evaluations, they were used.
Ten of them were also evaluated by corelsearcher for validation.
The PRISMA checklist is used to evaluate the reporting features, that is, the reporting quality, and the AMSTAR 2 checklist is used to evaluate the methodological quality of the system review.
For the research to be included, the quality of the method has received the highest attention, only the middle to high quality research is included.
PRISMA is a 27-item checklist.
The authors use the PRISMA statement to ensure a clear, complete and transparent system review.
22 The checklist contains seven sections/topics related to the relevant questions.
These answers are very strict with where they are found in the system review, which means that due to the checklist they must be found where they should be.
The answer "yes" is expressed as finding the page number, figure, or table of the item.
"No" or "not applicable" is expressed as a token.
When summed up, all the "yes" got 1 point, making the potential total score 27 points.
AMSTAR, published in boomerang, is widely used to evaluate the quality of methods reviews25-27 by Cochrane and non-Cochrane systems.
Cochrane overview of medical intervention.
28 AMSTAR was recently updated to AMSTAR 2 and is now up to 16-
Project online tools for evaluating high, medium, low, or extremely low system reviews of method quality.
24. Although AMSTAR 2 was not intended to produce an overall score, it was used for the purposes of this report to find the highest quality systematic review.
Based on the original AMSTAR tool, in order to rank system reviews as critical low (0–4u2009p), low (5–8), moderate (9–11)and high (12–16).
Two researchers evaluated the study separately.
Any disagreement was resolved through discussion to reach a consensus on the final score.
Summary evidence is based on the data provided in a systematic review of each included randomized controlled trial.
From the included systematic review only, individual randomized controlled trials were not evaluated and evaluated by major sources.
Evidence of the intervention was explained based on the p-values of CIs and randomized controlled trials reported in the systematic review.
The study was evaluated based on static significant results of predefined results.
"No effect" cut for risk ratio, relative risk, or risk difference and relative interest rate
The Off is set to 1, which means that if CIs crosses 1, the explanation is that the result is not statistically significant.
"No impact" cut for absolute risk and average difference-
Off is set to 0, which means that if 0 is within the CI of the result, the explanation is statistically meaningless.
A total of 854 studies have been identified in database search (figure 1).
After preliminary screening and sufficient
32 studies remain to be included before the quality assessment.
The online supplement Appendix 2 provides a detailed description of the studies excluded before the quality assessment.
Supplementary information [ejhpharm-2018-001725supp002. pdf]
Download the research flow chart for Figure 1 discovery, evaluation, exclusion and inclusion in the new tabDownload powerpoint.
AMSTAR, a measurement tool for evaluation system evaluation;
PRISMA, system review and Meta-Preferred Reporting ItemsAnalyses.
Quality assessment many systems do not have clear PICO (
Population, intervention, comparison group, results)
In their research questions or inclusion criteria.
This may be due to the fact that studies included in the systematic review already have its elements, for example, randomized controlled trials with control groups.
One accessible protocol is missing from many system reviews.
In the PRISMA checklist, the study gets a positive score when providing information about the existence of the protocol, but if the protocol is not found (
Pross search database)
As a result, there is a lack of scores in the AMSTAR 2 list.
There is also a lack of clear explanation for the research design selected in most systematic reviews.
Many system reviews do not provide a complete search strategy and do not search for gray literature.
Almost all systematic reviews report that research selection and extraction are repeated.
Most of the systematic reviews that are not Cochrane reviews do not provide a list of excluded studies and reasons for exclusion.
The Cochrane review provides the most detailed description of the studies included.
Almost every systematic review describes a satisfactory technique used to assess the risk of bias in individual studies, but often lacks reporting funding for individual studies.
So, including meta-
Due to the number of solving the meta problem, the analysis got a higher scoreanalysis.
Most SR reports heterogeneity because of its nature in interventions and outcome measurements.
Overall, funding was reported for systematic review and conflict of interest.
As shown in Table 1, more than half of the system reviews assessed were of low or very low quality.
The quality of 14 people was medium to high, of which 8 were selected for inclusive and consensus assessments.
The online supplement Appendix 3 provides a detailed description of the studies excluded after the quality assessment.
Supplementary information [ejhpharm-2018-001725supp003. pdf]
View this table: View the AMSTAR 2 checklist the inline View pop-up table 1 in the evaluation table 2 results give the PRISMA and AMSTAR 2 scores and consensus scores for both evaluators.
The online Supplementary Appendix 4 gives a detailed description of the evaluation results.
Supplementary information [ejhpharm-2018-001725supp004. docx]
View this table: View the inline View pop-up table 2 includes a systematic review of the evidence with PRISMA and AMSTAR 2. Eight system reviews included in this report were published between 2014 and 2018
Five of them are Cochrane reviews. Thirty-
From the systematic review, seven randomized controlled trials involving 28 600 patients published between 2000 and 2016 were extracted.
These studies mainly included adult patients of different ages.
The sample size of the population varies from n = 63 to n = 3260. Follow-
The rising time ranges from 12 weeks to 2 years.
Table 3 shows an overview of the results reported in the randomized controlled trials extracted from the systematic review.
The features of each system review and the results of the randomized controlled trials extracted from it are presented and listed in the online Supplementary Appendix 5.
Supplementary information [ejhpharm-2018-001725supp005. pdf]
View this table: View inline View pop-up table 3 Summary of results extracted from randomized controlled trials incorporated into the system review represents the results of the tables of randomized controlled trials reviewed by each system, A systematic review representing the type of intervention and the type of outcome is detailed in the online Supplementary Appendix 5.
Table 4 shows studies where the report has a positive, negative or mixed effect on the results.
The table does not include the effect of intervention on persistence.
These are described in Appendix 5 of the online supplement.
Supplementary Appendix 6 online and detailed descriptions of results based on the type of intervention in Supplementary Appendix 7 online.
A detailed reference list is given in Appendix 8 of the online supplement.
Supplementary information [ejhpharm-2018-001725supp006. pdf]
Supplementary information [ejhpharm-2018-001725supp007. pdf]
Supplementary information [ejhpharm-2018-001725supp008. pdf]
View this table: View inline View pop-up table 4 adhere to the intervention type and summary of the impact on the results.
According to a detailed description of each study in the online Supplementary Appendix 5, the most common type of intervention reported is patient education provided by pharmacists or nurses.
Compliance has reportedly improved in most studies that provide patient education.
Half of the research has improved in consultation.
In the study of intervention by a pharmacist who prescribed the drug, it is uncertain whether the intervention has any effect on adherence.
In all studies with doctors as intervenors, the intervention did not show an improvement in adherence.
Alert intervention, direct observation of treatment, network
The statistical-based programs and interventions implemented by doctors failed to show an improvement in results.
Simplified administration, patient education, and counseling, regardless of whether there is a pharmacist prescription, show a different effect.
There is evidence that patient education has a positive impact on morbidity and patient satisfaction.
Counselling has had a positive impact on mortality and health care utilization.
When the pharmacist prescribed the medicine, the incidence was also reduced.
Since most of these improvements are based on the results of a randomized controlled trial, the evidence is weak.
854 studies were found in database search (figure 1).
After preliminary screening and sufficient
32 studies remain to be included before the quality assessment.
The online supplement Appendix 2 provides a detailed description of the studies excluded before the quality assessment.
Supplementary information [ejhpharm-2018-001725supp002. pdf]
Download the research flow chart for Figure 1 discovery, evaluation, exclusion and inclusion in the new tabDownload powerpoint.
AMSTAR, a measurement tool for evaluation system evaluation;
PRISMA, system review and Meta-Preferred Reporting ItemsAnalyses.
Quality assessment many systems do not have clear PICO (
Population, intervention, comparison group, results)
In their research questions or inclusion criteria.
This may be due to the fact that studies included in the systematic review already have its elements, for example, randomized controlled trials with control groups.
One accessible protocol is missing from many system reviews.
In the PRISMA checklist, the study gets a positive score when providing information about the existence of the protocol, but if the protocol is not found (
Pross search database)
As a result, there is a lack of scores in the AMSTAR 2 list.
There is also a lack of clear explanation for the research design selected in most systematic reviews.
Many system reviews do not provide a complete search strategy and do not search for gray literature.
Almost all systematic reviews report that research selection and extraction are repeated.
Most of the systematic reviews that are not Cochrane reviews do not provide a list of excluded studies and reasons for exclusion.
The Cochrane review provides the most detailed description of the studies included.
Almost every systematic review describes a satisfactory technique used to assess the risk of bias in individual studies, but often lacks reporting funding for individual studies.
So, including meta-
Due to the number of solving the meta problem, the analysis got a higher scoreanalysis.
Most SR reports heterogeneity because of its nature in interventions and outcome measurements.
Overall, funding was reported for systematic review and conflict of interest.
As shown in Table 1, more than half of the system reviews assessed were of low or very low quality.
The quality of 14 people was medium to high, of which 8 were selected for inclusive and consensus assessments.
The online supplement Appendix 3 provides a detailed description of the studies excluded after the quality assessment.
Supplementary information [ejhpharm-2018-001725supp003. pdf]
View this table: View the AMSTAR 2 checklist the inline View pop-up table 1 in the evaluation table 2 results give the PRISMA and AMSTAR 2 scores and consensus scores for both evaluators.
The online Supplementary Appendix 4 gives a detailed description of the evaluation results.
Supplementary information [ejhpharm-2018-001725supp004. docx]
View this table: View the inline View pop-up table 2 includes a systematic review of the evidence with PRISMA and AMSTAR 2. Eight system reviews included in this report were published between 2014 and 2018
Five of them are Cochrane reviews. Thirty-
From the systematic review, seven randomized controlled trials involving 28 600 patients published between 2000 and 2016 were extracted.
These studies mainly included adult patients of different ages.
The sample size of the population varies from n = 63 to n = 3260. Follow-
The rising time ranges from 12 weeks to 2 years.
Table 3 shows an overview of the results reported in the randomized controlled trials extracted from the systematic review.
The features of each system review and the results of the randomized controlled trials extracted from it are presented and listed in the online Supplementary Appendix 5.
Supplementary information [ejhpharm-2018-001725supp005. pdf]
View this table: View inline View pop-up table 3 Summary of results extracted from randomized controlled trials incorporated into the system review represents the results of the tables of randomized controlled trials reviewed by each system, A systematic review representing the type of intervention and the type of outcome is detailed in the online Supplementary Appendix 5.
Table 4 shows studies where the report has a positive, negative or mixed effect on the results.
The table does not include the effect of intervention on persistence.
These are described in Appendix 5 of the online supplement.
Supplementary Appendix 6 online and detailed descriptions of results based on the type of intervention in Supplementary Appendix 7 online.
A detailed reference list is given in Appendix 8 of the online supplement.
Supplementary information [ejhpharm-2018-001725supp006. pdf]
Supplementary information [ejhpharm-2018-001725supp007. pdf]
Supplementary information [ejhpharm-2018-001725supp008. pdf]
View this table: View inline View pop-up table 4 adhere to the intervention type and summary of the impact on the results.
According to a detailed description of each study in the online Supplementary Appendix 5, the most common type of intervention reported is patient education provided by pharmacists or nurses.
Compliance has reportedly improved in most studies that provide patient education.
Half of the research has improved in consultation.
In the study of intervention by a pharmacist who prescribed the drug, it is uncertain whether the intervention has any effect on adherence.
In all studies with doctors as intervenors, the intervention did not show an improvement in adherence.
Alert intervention, direct observation of treatment, network
The statistical-based programs and interventions implemented by doctors failed to show an improvement in results.
Simplified administration, patient education, and counseling, regardless of whether there is a pharmacist prescription, show a different effect.
There is evidence that patient education has a positive impact on morbidity and patient satisfaction.
Counselling has had a positive impact on mortality and health care utilization.
When the pharmacist prescribed the medicine, the incidence was also reduced.
Since most of these improvements are based on the results of a randomized controlled trial, the evidence is weak.
The results of the study conducted through consultation interventions showed a decrease in mortality and health care utilization and an improvement in compliance.
Patient education shows improved patient satisfaction and has some benefits for mortality and health care utilization, while patient education shows a decrease in incidence in addition to pharmacist prescription medication.
Educational intervention has a great positive impact on persistence.
The simplification of the dose showed an improvement in incidence and patient satisfaction, with a mixed effect on compliance.
However, in all of the results of interest in this study, effective interventions were not shown, suggesting that the choice of intervention should be consistent with the type of challenge that patients adhere.
How to measure persistence is not of no importance, because these methods may have an unexpected impact on the results, E. G.
Report or excess
Patient Self-report
Report, record the opening of the drug container, but actually do not record the electronic drug monitor of whether the patient is taking the drug, etc.
However, this is not the focus of this report, nor is it reported.
There are several limitations to this study.
This report only includes a systematic review of the acquisition of medium to high AMSTAR 2 points.
Due to quality assessment, there may be individual high-quality studies that have been left out in lower quality system reviews.
A major limitation was the lack of evaluation of bias in a single randomized controlled trial.
However, the authors of the systematic review have assessed bias.
The report data is incomplete to a certain extent.
This may have been caused by selective reporting, but has not been reviewed.
The literature search for this report is limited to systematic reviews published in the past 10 years (2007–2017)
Although two system reviews were included in 2018, one
Comprehensive Google search for system reviews released in 2018.
The language is limited to English only, so this report is prone to language bias, and it is possible to miss the non-
English Journal.
This search is not for unpublished research (
"Gray literature ")
But some systematic comments include unpublished research.
Some studies may be excluded due to the vague coverage of the intervention.
The excluded study reports were only "health care professionals" as intervenors.
Because this report is limited to intervenors such as pharmacists, nurses or clinicians, the results of this report may be compared with the middle and high
Countries with low incomes
Income countries are more likely to use
Non-professional health care professionals or community workers act as intervenors.
Instead of a systematic review that fully matches the purpose and inclusion criteria of this report, a single randomized controlled trial meeting inclusion criteria was extracted from the systematic review. Likewise, meta-
Analysis in the systematic review was not available, which made it less clinically and statistically powerful when extracting individual randomized controlled trials.
Overall, these studies differ in terms of population type, type and length of intervention, and the outcome of the measurements.
There is a big difference in how to measure persistence and what is considered "good persistence.
Some studies are complex and have several components in the intervention, so there is a certain degree of overlap between studies, so it is difficult to divide them in a rigid way.
By using individual studies in systematic reviews rather than the primary source itself, another limitation is that systematic review authors may misunderstand.
If the author does not explain the results of his or her own personal study, any correct or incorrect explanation will be followed further.
Major studies have been added so that they can be found and they have not been evaluated by the authors of this report.
The study is planned as a master's program in pharmacy.
Three students conducted similar studies on different interventions aimed at improving important outcomes.
In this study, students (NCW)
Perform all activities supervised by TE.
A collaborative researcher also conducted a quality assessment.
Since this report is mainly conducted by a student, there is no expertise like professional research, so it is easier to expose defects.
Prior to carrying out the work of this report, the researchers did not receive any training on the quality assessment of the system review, but gained experience through this process.
This may lead to a difference in the way the first quality assessment is considered compared to the last quality assessment.
However, in order to maintain consistency, it involves changes in some previous quality assessments.
The report may be interesting for several readers.
For health care decision makers, this report provides insight into which interventions and interventions show improved compliance and/or clinical, economic and human outcomes.
In other words, it is reasonable to invest in which type of intervention resource.
For researchers who plan to conduct similar studies, new studies can be conducted based on the study in this report.
For healthcare professionals who wish to raise awareness and knowledge of adherence to interventions and who wish to use them in practice.
Finally, the report is also interesting for patients and drug consumers as they realize the challenges of not being able to stick enough.
Conclusions it was found that some interventions had a positive effect on adherence and outcome, but in all cases there was no single strategy showing improvement.
For future studies, non-patients should be screened
If neither is true, stick to revealing them.
Non-adhesion and type
Adhesion, as well as larger sample size and longer follow timeup.
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Statement 6: education and research.
The study is planned as a master's program in pharmacy. The student (NCW)
Perform all activities supervised by TE in the MSc report.
According to the MSc report, we wrote this manuscript together.
Funding authors have not announced specific funding for this study from any public, commercial or non-commercial funding agency --for-profit sectors.
No one declared a competitive interest.
Patient consent is not required.
Uncommissioned source and peer review;
External peer review.