Nurse interventions to improve medication adherence among discharged older adults
Age and Ageing 2017; 46: 747–754 doi: 10.1093/ageing/afx076 Published electronically 16 May 2017
© The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com
Nurse interventions to improve medication adherence among discharged older adults: a systematic review
HENK VERLOO1,4, ARNAUD CHIOLERO2,3, BLANCHE KISZIO4, THOMAS KAMPEL4, VALÉRIE SANTSCHI4,5
1School of Health sciences, HES-SO Valais — Wallis, University of Applied sciences Western Switzerland, Chémin de l’Agasse 6, Sion, Switzerland 2IUMSP, Lausanne University Hospital, Lausanne, Switzerland 3Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland 4La Source, School of Nursing Sciences, University of Applied Sciences Western Switzerland, Lausanne, Switzerland 5Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland
Address correspondence to: H. Verloo. Tel: +41 27 606 84 24; Fax +41 27 606 84 01. Email: henk.verloo@unil.ch
Abstract
Background: discharged older adult inpatients are often prescribed numerous medications. However, they only take about half of their medications and many stop treatments entirely. Nurse interventions could improve medication adherence among this population. Objective: to conduct a systematic review of trials that assessed the effects of nursing interventions to improve medication adherence among discharged, home-dwelling and older adults. Method: we conducted a systematic review according to the methods in the Cochrane Collaboration Handbook and reported results according to the PRISMA statement. We searched for controlled clinical trials (CCTs) and randomised CCTs (RCTs), published up to 8 November 2016 (using electronic databases, grey literature and hand searching), that evalu- ated the effects of nurse interventions conducted alone or in collaboration with other health professionals to improve medi- cation adherence among discharged older adults. Medication adherence was defined as the extent to which a patient takes medication as prescribed. Results: out of 1,546 records identified, 82 full-text papers were evaluated and 14 studies were included—11 RCTs and 2 CCTs. Overall, 2,028 patients were included (995 in intervention groups; 1,033 in usual-care groups). Interventions were nurse-led in seven studies and nurse-collaborative in seven more. In nine studies, adherence was higher in the intervention group than in the usual-care group, with the difference reaching statistical significance in eight studies. There was no sub- stantial difference in increased medication adherence whether interventions were nurse-led or nurse-collaborative. Four of the 14 studies were of relatively high quality. Conclusion: nurse-led and nurse-collaborative interventions moderately improved adherence among discharged older adults. There is a need for large, well-designed studies using highly reliable tools for measuring medication adherence.
Keywords: medication adherence, nurse intervention, nurse-led interventions, nurse-collaborative interventions, systematic review, older people
Background
Medication adherence—defined as the extent to which patients take medication as prescribed by their healthcare professionals—is an important aspect of treatment efficacy, healthcare costs and patient safety [1, 2]. Medication
adherence also implies the notion of concordance, i.e. a process of shared decision-making between patients and healthcare professionals [3]. According to a WHO report, inadequate medication adherence averaged 50% among patients with a chronic disease [4] and represented a signi- ficant problem that led to increased morbidity and
