OBJECTIVES: Medication nonadherence is associated with worsening of health outcomes and increasing healthcare costs among patients with both oncological and non-oncological chronic conditions. A targeted literature review was undertaken to describe interventions for improving long-term adherence to oral medication and to summarize their effectiveness.
METHODS: Medline and Embase were searched for publications reported in English from 8 August 2014 to 8 August 2024. Additional articles were identified from bibliographies of relevant systematic and comprehensive literature reviews. Included studies comprised interventions to improve long-term (≥3 months) adherence or persistence for patients with cancer or other chronic illnesses who were prescribed daily or frequently administered oral medications.
RESULTS: Of 51 studies included, 37 were in oncology populations and 14 were in non-oncology populations. There were 32 randomized controlled trials and 19 cohort studies. The interventions were categorized as pharmacist-/physician-led (oncology [n=11]; non-oncology [n=4]), nurse-/other healthcare professional (HCP)-led (oncology [n=14]; non-oncology [n=5]), digital app/device/voice response system (oncology [n=8]; non-oncology [n=6]), or education only (oncology [n=4]; non-oncology [n=0]). Nearly three-quarters (73%; 11/15) of the pharmacist-/physician-led intervention studies showed a statistically significant improvement in adherence or persistence either when compared with pre-intervention levels or usual care, and 67% of these studies were nonrandomized comparative studies. Adherence/persistence improved in half (50%; 9/18) of nurse-/HCP-led and less than half (40%; 6/15) of digital/device/voice response interventions. Notably, none of the education-only interventions resulted in improved adherence. Studies with large (≥10% increase) and statistically significant improvements in adherence or persistence included multidimensional interventions addressing patient knowledge, side-effect/symptom barriers, forgetfulness, and communication with an HCP.
CONCLUSIONS: More pharmacist-/physician-led interventions showed significantly improved adherence/persistence compared with nurse/HCP-led, digital/device/voice response, or education-only interventions. Future adherence/persistence interventions should consider including contact with pharmacists, side-effect or symptom management, daily or weekly reminders, and patient education as part of the intervention package.
