A systematic review of community-based interventions to improve oral chronic disease medication regimen adherence among individuals with substance use disorder

Karen M Clements; Tasmina Hydery; Mark A Tesell; Bonnie C Greenwood; Michael C Angelini

doi:10.1016/j.drugalcdep.2018.03.039

A systematic review of community-based interventions to improve oral chronic disease medication regimen adherence among individuals with substance use disorder

Drug Alcohol Depend. 2018 Jul 1:188:141-152. doi: 10.1016/j.drugalcdep.2018.03.039. Epub 2018 May 1.

Authors

Karen M Clements¹, Tasmina Hydery², Mark A Tesell², Bonnie C Greenwood², Michael C Angelini³

Affiliations

¹ Center for Health Policy and Research, University of Massachusetts Medical School, 333 South Street, Shrewsbury, MA, 01545, USA. Electronic address: Karen.clements@umassmed.edu.
² Clinical Pharmacy Services, University of Massachusetts Medical School, 333 South Street, Shrewsbury, MA, 01545, USA.
³ Massachusetts College of Pharmacy and Health Sciences University, 179 Longwood Avenue, Boston, MA, 02155, USA.

PMID: 29775958
DOI: 10.1016/j.drugalcdep.2018.03.039

Abstract

Background: Poor medication adherence has been shown to cause medical complications, death, and increased healthcare costs and may be of particular importance in patients with substance use disorder (SUD). Concerns regarding adherence in this population may influence a healthcare provider's decision to prescribe a medication requiring high adherence. Guidance defining best practices that promote adherence among individuals with SUD is lacking.

Methods: A review of English articles in Medline and PsycINFO databases, published between October 1, 1994 and October 31, 2017, was conducted in order to identify studies of interventions intended to improve adherence to oral chronic disease medication regimens among patients with SUD. Randomized controlled trials, quasi-experimental study designs, and case series were included. Article quality was assessed.

Results: A total of 854 abstracts were retrieved, of which 24 met inclusion criteria. Adherence interventions were categorized as those: 1) addressing the chronic disease state; 2) addressing SUD; or 3) both. Studies varied greatly with respect to intervention length, method of measuring adherence, and quality. Statistically significant improvement in adherence was observed in 12 of 24 studies (50%). Specific interventions that improved adherence included incentive-based interventions, directly observed therapy, and telephonic/home visits. Counseling-based interventions such motivational interviewing and cognitive behavioral therapy presented mixed results.

Conclusions: While effective interventions were identified, heterogeneity of study designs and study quality preclude determination of optimal interventions to promote adherence in this population. Further evaluation with sound study design may inform the development of best practices for treating chronic disease in patients with SUD.

Keywords: Medication adherence; Substance use disorder; Systematic review.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Administration, Oral
Chronic Disease
Cognitive Behavioral Therapy / methods
Community Health Services / methods*
Humans
Medication Adherence / psychology*
Motivational Interviewing / methods
Randomized Controlled Trials as Topic / methods
Substance-Related Disorders / diagnosis
Substance-Related Disorders / psychology*
Substance-Related Disorders / therapy*