The Development of a Framework on Approaches to Adherence Best Practices for Health Plans: A Systematic Review

Background: Roughly 50% of all patients do not adhere to their medication regimens. Root causes for nonadherence are complex and usually involve a variety of factors. A one size fits all approach to intervention programs would likely only yield suboptimal outcomes. Tailoring interventions according to patient characteristics can increase the likelihood of adherence intervention effectiveness. Purpose: The objective of this study was to review the literature within the past decade to develop a framework for best practices in health plan use of medication adherence interventions, with respect to patient perceptions, cultural competence, patient characteristics, and timing and frequency. Methods: This systematic review was conducted using PubMed, SCOPUS, Cinahl Complete, and Global Health databases to obtain articles published in the US from 2007 to 2017. Search terms used included: “medication adherence”, “interventions”, “program evaluation”, “text”, “phone”, “mail”, “visits”, “in person, “acceptability”, “patient preference”, “cultural competency”, “health literacy, “patient perceptions”, “smartphone”, “electronic mail”, “support groups”, “drug”, “medication” and “efficacy”. Abstracts were screened according to broad inclusion and exclusion criteria. Articles were read in detail and graded by Oxford Evidence-Based Grading System. Selected articles were categorized by adherence intervention: telephone outreach, provider-centric, and face-to-face visits. Results: Preliminary findings based on 79 articles retrieved thus far show that studies assessing patient perceptions of telephone interventions in the form of text messaging and mobile apps, prove high acceptability. Face-to-face visits in the form of behavioral-based family counseling have high acceptability among adolescent populations while provider-centric interventions appear to be highly dependent on the patient-provider relationship. Studies assessing cultural competence primarily show usefulness in provider-centric interventions and face-to-face visits as compared to telephone, and trend toward better efficacy in immigrant and low health literacy populations. Conclusion: Next steps in the conduct of this research will include an examination of the impact of patient characteristics (race, age, gender, marital status, SES and disease severity) on the effectiveness of adherence interventions.