An innovative and comprehensive technique to evaluate different measures of medication adherence: The network meta-analysis

Tonin, FS; Wiecek, E; Torres-Robles, A; Pontarolo, R; Benrimoj, SI; Fernandez-Llimos, F; Garcia-Cardenas, V

An innovative and comprehensive technique to evaluate different measures of medication adherence: The network meta-analysis

Tonin, FS Wiecek, E Torres-Robles, A

Pontarolo, R Benrimoj, SI

Fernandez-Llimos, F

Garcia-Cardenas, V

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Publication Type:: Journal Article
Citation:: Research in Social and Administrative Pharmacy, 2019, 15 (4), pp. 358 - 365
Issue Date:: 2019-04-01

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Field	Value	Language
dc.contributor.author	Tonin, FS	en_US
dc.contributor.author	Wiecek, E	en_US
dc.contributor.author	Torres-Robles, A https://orcid.org/0000-0002-8751-5706	en_US
dc.contributor.author	Pontarolo, R	en_US
dc.contributor.author	Benrimoj, SI https://orcid.org/0000-0001-9768-7838	en_US
dc.contributor.author	Fernandez-Llimos, F https://orcid.org/0000-0002-8529-9595	en_US
dc.contributor.author	Garcia-Cardenas, V https://orcid.org/0000-0003-3770-4557	en_US
dc.date.available	2020-05-25T19:20:21Z
dc.date.issued	2019-04-01	en_US
dc.identifier.citation	Research in Social and Administrative Pharmacy, 2019, 15 (4), pp. 358 - 365	en_US
dc.identifier.issn	1551-7411	en_US
dc.identifier.uri	http://hdl.handle.net/10453/124504
dc.description.abstract	© 2018 Elsevier Inc. Background: Poor medication adherence is associated with adverse health outcomes and higher costs of care. However, inconsistencies in the assessment of adherence are found in the literature. Objective: To evaluate the effect of different measures of adherence in the comparative effectiveness of complex interventions to enhance patients’ adherence to prescribed medications. Methods: A systematic review with network meta-analysis was performed. Electronic searches for relevant pairwise meta-analysis including trials of interventions that aimed to improve medication adherence were performed in PubMed. Data extraction was conducted with eligible trials evaluating short-period adherence follow-up (until 3 months) using any measure of adherence: self-report, pill count, or MEMS (medication event monitoring system). To standardize the results obtained with these different measures, an overall composite measure and an objective composite measure were also calculated. Network meta-analyses for each measure of adherence were built. Rank order and surface under the cumulative ranking curve analyses (SUCRA) were performed. Results: Ninety-one trials were included in the network meta-analyses. The five network meta-analyses demonstrated robustness and reliability. Results obtained for all measures of adherence were similar across them and to both composite measures. For both composite measures, interventions comprising economic + technical components were the best option (90% of probability in SUCRA analysis) with statistical superiority against almost all other interventions and against standard care (odds ratio with 95% credibility interval ranging from 0.09 to 0.25 [0.02, 0.98]). Conclusion: The use of network meta-analysis was reliable to compare different measures of adherence of complex interventions in short-periods follow-up. Analyses with longer follow-up periods are needed to confirm these results. Different measures of adherence produced similar results. The use of composite measures revealed reliable alternatives to establish a broader and more detailed picture of adherence.	en_US
dc.relation.ispartof	Research in Social and Administrative Pharmacy	en_US
dc.relation.isbasedon	10.1016/j.sapharm.2018.05.010	en_US
dc.subject.classification	Pharmacology & Pharmacy	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Randomized Controlled Trials as Topic	en_US
dc.subject.mesh	Medication Adherence	en_US
dc.subject.mesh	Network Meta-Analysis	en_US
dc.title	An innovative and comprehensive technique to evaluate different measures of medication adherence: The network meta-analysis	en_US
dc.type	Journal Article
utslib.citation.volume	4	en_US
utslib.citation.volume	15	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1115 Pharmacology and Pharmaceutical Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Graduate School of Health
utslib.copyright.status	open_access
pubs.issue	4	en_US
pubs.publication-status	Published	en_US
pubs.volume	15	en_US

Abstract:

© 2018 Elsevier Inc. Background: Poor medication adherence is associated with adverse health outcomes and higher costs of care. However, inconsistencies in the assessment of adherence are found in the literature. Objective: To evaluate the effect of different measures of adherence in the comparative effectiveness of complex interventions to enhance patients’ adherence to prescribed medications. Methods: A systematic review with network meta-analysis was performed. Electronic searches for relevant pairwise meta-analysis including trials of interventions that aimed to improve medication adherence were performed in PubMed. Data extraction was conducted with eligible trials evaluating short-period adherence follow-up (until 3 months) using any measure of adherence: self-report, pill count, or MEMS (medication event monitoring system). To standardize the results obtained with these different measures, an overall composite measure and an objective composite measure were also calculated. Network meta-analyses for each measure of adherence were built. Rank order and surface under the cumulative ranking curve analyses (SUCRA) were performed. Results: Ninety-one trials were included in the network meta-analyses. The five network meta-analyses demonstrated robustness and reliability. Results obtained for all measures of adherence were similar across them and to both composite measures. For both composite measures, interventions comprising economic + technical components were the best option (90% of probability in SUCRA analysis) with statistical superiority against almost all other interventions and against standard care (odds ratio with 95% credibility interval ranging from 0.09 to 0.25 [0.02, 0.98]). Conclusion: The use of network meta-analysis was reliable to compare different measures of adherence of complex interventions in short-periods follow-up. Analyses with longer follow-up periods are needed to confirm these results. Different measures of adherence produced similar results. The use of composite measures revealed reliable alternatives to establish a broader and more detailed picture of adherence.

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http://hdl.handle.net/10453/124504