Nurse interventions to improve medication adherence among discharged older adults: a systematic review

Henk Verloo; Arnaud Chiolero; Blanche Kiszio; Thomas Kampel; Valérie Santschi

doi:10.1093/ageing/afx076

Nurse interventions to improve medication adherence among discharged older adults: a systematic review

Age Ageing. 2017 Sep 1;46(5):747-754. doi: 10.1093/ageing/afx076.

Authors

Henk Verloo^{1

2}, Arnaud Chiolero^{3

4}, Blanche Kiszio², Thomas Kampel², Valérie Santschi^{2

5}

Affiliations

¹ School of Health sciences, HES-SO Valais - Wallis, University of Applied sciences Western Switzerland, Chémin de l'Agasse 6, Sion, Switzerland.
² La Source, School of Nursing Sciences, University of Applied Sciences Western Switzerland, Lausanne, Switzerland.
³ IUMSP, Lausanne University Hospital, Lausanne, Switzerland.
⁴ Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
⁵ Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland.

PMID: 28510645
DOI: 10.1093/ageing/afx076

Abstract

Background: discharged older adult inpatients are often prescribed numerous medications. However, they only take about half of their medications and many stop treatments entirely. Nurse interventions could improve medication adherence among this population.

Objective: to conduct a systematic review of trials that assessed the effects of nursing interventions to improve medication adherence among discharged, home-dwelling and older adults.

Method: we conducted a systematic review according to the methods in the Cochrane Collaboration Handbook and reported results according to the PRISMA statement. We searched for controlled clinical trials (CCTs) and randomised CCTs (RCTs), published up to 8 November 2016 (using electronic databases, grey literature and hand searching), that evaluated the effects of nurse interventions conducted alone or in collaboration with other health professionals to improve medication adherence among discharged older adults. Medication adherence was defined as the extent to which a patient takes medication as prescribed.

Results: out of 1,546 records identified, 82 full-text papers were evaluated and 14 studies were included-11 RCTs and 2 CCTs. Overall, 2,028 patients were included (995 in intervention groups; 1,033 in usual-care groups). Interventions were nurse-led in seven studies and nurse-collaborative in seven more. In nine studies, adherence was higher in the intervention group than in the usual-care group, with the difference reaching statistical significance in eight studies. There was no substantial difference in increased medication adherence whether interventions were nurse-led or nurse-collaborative. Four of the 14 studies were of relatively high quality.

Conclusion: nurse-led and nurse-collaborative interventions moderately improved adherence among discharged older adults. There is a need for large, well-designed studies using highly reliable tools for measuring medication adherence.

Keywords: medication adherence; nurse intervention; nurse-collaborative interventions; nurse-led interventions; older people; systematic review.

Publication types

Review
Systematic Review

MeSH terms

Age Factors
Aged
Aged, 80 and over
Aging / psychology*
Delivery of Health Care, Integrated
Female
Health Knowledge, Attitudes, Practice*
Humans
Male
Medication Adherence*
Middle Aged
Nurse's Role*
Nurses*
Patient Care Team
Patient Discharge*
Polypharmacy