Document Detail


A systematic review of adherence to cardiovascular medications in resource-limited settings.
MedLine Citation:
PMID:  21858602     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Ashna D K Bowry; William H Shrank; Joy L Lee; Margaret Stedman; Niteesh K Choudhry
Publication Detail:
Type:  Journal Article; Review     Date:  2011-08-20
Journal Detail:
Title:  Journal of general internal medicine     Volume:  26     ISSN:  1525-1497     ISO Abbreviation:  J Gen Intern Med     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-11-15     Completed Date:  2012-08-07     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1479-91     Citation Subset:  IM    
Affiliation:
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA.
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MeSH Terms
Descriptor/Qualifier:
Cardiovascular Agents / 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:
T32 AR055885/AR/NIAMS NIH HHS
Chemical
Reg. No./Substance:
0/Cardiovascular Agents
Comments/Corrections
Comment In:
J Gen Intern Med. 2011 Dec;26(12):1391-3   [PMID:  21879369 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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