| A systematic review of adherence to cardiovascular medications in resource-limited settings. | |
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MedLine Citation:
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PMID: 21858602 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Medications are a cornerstone of the prevention and management of cardiovascular disease. Long-term medication adherence has been the subject of increasing attention in the developed world but has received little attention in resource-limited settings, where the burden of disease is particularly high and growing rapidly. To evaluate prevalence and predictors of non-adherence to cardiovascular medications in this context, we systematically reviewed the peer-reviewed literature. METHODS: We performed an electronic search of Ovid Medline, Embase and International Pharmaceutical Abstracts from 1966 to August 2010 for studies that measured adherence to cardiovascular medications in the developing world. A DerSimonian-Laird random effects method was used to pool the adherence estimates across studies. Between-study heterogeneity was estimated with an I(2) statistic and studies were stratified by disease group and the method by which adherence was assessed. Predictors of non-adherence were also examined. FINDINGS: Our search identified 2,353 abstracts, of which 76 studies met our inclusion criteria. Overall adherence was 57.5% (95% confidence interval [CI] 52.3% to 62.7%; I(2) 0.98) and was consistent across study subgroups. Studies that assessed adherence with pill counts reported higher levels of adherence (62.1%, 95% CI 49.7% to 73.8%; I(2) 0.83) than those using self-report (54.6%, 95% CI 47.7% to 61.5%; I(2) 0.93). Adherence did not vary by geographic region, urban vs. rural settings, or the complexity of a patient's medication regimen. The most common predictors of poor adherence included poor knowledge, negative perceptions about medication, side effects and high medication costs. INTERPRETATION: Our study indicates that adherence to cardiovascular medication in resource-limited countries is sub-optimal and appears very similar to that observed in resource-rich countries. Efforts to improve adherence in resource-limited settings should be a priority given the burden of heart disease in this context, the central role of medications in their management, and the clinical and economic consequences of non-adherence. |
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Authors:
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Ashna D K Bowry; William H Shrank; Joy L Lee; Margaret Stedman; Niteesh K Choudhry |
Publication Detail:
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Type: Journal Article; Review Date: 2011-08-20 |
Journal Detail:
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Title: Journal of general internal medicine Volume: 26 ISSN: 1525-1497 ISO Abbreviation: J Gen Intern Med Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2011-11-15 Completed Date: 2012-08-07 Revised Date: 2013-05-23 |
Medline Journal Info:
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Nlm Unique ID: 8605834 Medline TA: J Gen Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 1479-91 Citation Subset: IM |
Affiliation:
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Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Cardiovascular Agents
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economics*,
therapeutic use Cardiovascular Diseases / drug therapy, economics*, epidemiology Developing Countries / economics*, statistics & numerical data Health Resources / economics*, statistics & numerical data Humans Medication Adherence* / statistics & numerical data |
| Grant Support | |
ID/Acronym/Agency:
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T32 AR055885/AR/NIAMS NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Cardiovascular Agents |
| Comments/Corrections | |
Comment In:
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J Gen Intern Med. 2011 Dec;26(12):1391-3
[PMID:
21879369
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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