HCP-led interventions targeting medication adherence following acute coronary syndrome: systematic review and meta-analysis

Abstract

Background: Suboptimal medication adherence following acute coronary syndrome (ACS) is associated with poor clinical outcomes and healthcare providers (HCP) play a key role in supporting patients with their medications. This study was undertaken to determine the effectiveness of HCP-led interventions to improve medication adherence in ACS patients. Methods: A systematic search of Cochrane Library, Medline, EMBASE, PsycINFO, Web of Science, International Pharmaceutical Abstracts, CINAHL, ASSIA, OpenGrey, EthOS, WorldCat and PQDT was performed and studies were screened against our PICOS-based eligibility criteria. Data on study design, sample characteristics, intervention features and outcomes were abstracted and intervention content was coded using the Behaviour Change Technique (BCT) Taxonomy (v1). Findings: Our search identified 7013 records, of which 21 met our eligibility criteria (18 independent studies). A meta-analysis revealed a small but significant effect for HCP-led interventions (n = 7752) on medication adherence (SMD 0.25, 95% CI 0.13 – 0.37, I2 = 57%). Subgroup analysis revealed that the type of interventionist, delivery method and having a theory-based design did not impact on effectiveness. A total of 28/93 BCTs were identified across interventions (range 1 – 10) with ‘information about health consequences’ (15/18) and ‘goal setting (outcomes)’ (6/18) the most common. Discussion: HCP-led interventions for ACS patients appear to have a small positive impact on medication adherence. The was no evidence that the type of interventionist, delivery method or whether studies were based on theory had an impact on study effectiveness. Providing information about the health consequences of non-adherence was the most frequently used BCT.