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    Physician effectiveness in interventions to improve cardiovascular medication adherence: a systematic review

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    Authors
    Cutrona, Sarah L.
    Choudhry, Niteesh K.
    Stedman, Margaret R.
    Servi, Amber
    Liberman, Joshua N.
    Brennan, Troyen
    Fischer, Michael A.
    Brookhart, M. Alan
    Shrank, William H.
    UMass Chan Affiliations
    Meyers Primary Care Institute
    Document Type
    Journal Article
    Publication Date
    2010-10-14
    Keywords
    Cardiovascular Agents
    Cardiovascular Diseases
    Health Personnel
    Humans
    *Medication Adherence
    *Physician's Role
    Randomized Controlled Trials as Topic
    Cardiovascular Diseases
    Health Services Research
    
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    Link to Full Text
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2955481/pdf/11606_2010_Article_1387.pdf
    Abstract
    BACKGROUND: Medications for the prevention and treatment of cardiovascular disease save lives but adherence is often inadequate. The optimal role for physicians in improving adherence remains unclear. OBJECTIVE: Using existing evidence, we set the goal of evaluating the physician's role in improving medication adherence. DESIGN: We conducted systematic searches of English-language peer-reviewed publications in MEDLINE and EMBASE from 1966 through 12/31/2008. SUBJECTS AND INTERVENTIONS: We selected randomized controlled trials of interventions to improve adherence to medications used for preventing or treating cardiovascular disease or diabetes. MAIN MEASURES: Articles were classified as either (1) physician "active"-a physician participated in designing or implementing the intervention; (2) physician "passive"-physicians treating intervention group patients received patient adherence information while physicians treating controls did not; or (3) physicians noninvolved. We also identified studies in which healthcare professionals helped deliver the intervention. We did a meta-analysis of the studies involving healthcare professionals to determine aggregate Cohen's D effect sizes (ES). KEY RESULTS: We identified 6,550 articles; 168 were reviewed in full, 82 met inclusion criteria. The majority of all studies (88.9%) showed improved adherence. Physician noninvolved studies were more likely (35.0% of studies) to show a medium or large effect on adherence compared to physician-involved studies (31.3%). Among interventions requiring a healthcare professional, physician-noninvolved interventions were more effective (ES 0.47; 95% CI 0.38-0.56) than physician-involved interventions (ES 0.25; 95% CI 0.21-0.29; p < 0.001). Among physician-involved interventions, physician-passive interventions were marginally more effective (ES 0.29; 95% CI 0.22-0.36) than physician-active interventions (ES 0.23; 95% CI 0.17-0.28; p = 0.2). CONCLUSIONS: Adherence interventions utilizing non-physician healthcare professionals are effective in improving cardiovascular medication adherence, but further study is needed to identify the optimal role for physicians.
    Source
    J Gen Intern Med. 2010 Oct;25(10):1090-6. Epub 2010 May 13. Link to article on publisher's site
    DOI
    10.1007/s11606-010-1387-9
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/36862
    PubMed ID
    20464522
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1007/s11606-010-1387-9
    Scopus Count
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