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Association between medication regimen complexity and pharmacotherapy adherence: a systematic review

  • Pharmacoepidemiology and Prescription
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Abstract

Purpose

The purpose of this study was to systematically review evidence regarding the association between regimen complexity and adherence.

Methods

Articles were searched in MEDLINE, LILACS, Cochrane, CINAHL, PsycINFO and references of included studies. Search terms included medication regimen complexity, medication adherence and their synonyms. Randomized clinical trials, cross-sectional, cohort or case-control studies published until March 2016 in English, Portuguese or Spanish were eligible if quantitatively examined the association between complexity and adherence in patients of any age and sex, under any type of medication therapy. Complexity was defined according to the strategy used to assess it in the individual studies. All types of instruments used to assess complexity and adherence were considered. Data extraction was performed using an electronic spreadsheet. Quality assessment was conducted independently using standard scales. The data were qualitatively synthesized.

Results

Fifty-four studies were included: 37 cross-sectional and 17 cohorts. Most were conducted in outpatient setting. Most frequently, studies were carried out with HIV-infected individuals or patients with chronic conditions. The most frequent methods used to assess complexity and adherence were complexity index (19) and self-report (27), respectively. Complexity was associated with adherence in 35 studies. Most of them (28) identified that participants with more complex regimens were less likely to adhere to pharmacotherapy; seven studies found a direct correlation. The others found inconclusive results or no association between complexity and adherence. The studies had low to moderate-methodological quality.

Conclusion

Although there was variability regarding the association between complexity and adherence, most studies showed that an increased regimen complexity reduces medication adherence.

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Acknowledgements

This study was supported by Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) and by Pró-reitoria de Pesquisa da Universidade Federal de Minas Gerais (UFMG).

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  1. Faculdade de Farmácia da Universidade Federal de Minas Gerais, Avenida Antônio Carlos 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil

    Laís Lessa Pantuzza, Maria das Graças Braga Ceccato, Micheline Rosa Silveira, Luane Mendes Ribeiro Junqueira & Adriano Max Moreira Reis

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  1. Laís Lessa Pantuzza
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LLP was responsible for the study and protocol design, study screening and selection, data extraction, quality assessment, drafting of the manuscript, critical review and approval of the final manuscript. AMMR was responsible for the study and protocol design, study screening and selection, quality assessment, drafting of the manuscript, critical review and approval of the final manuscript. MGBC was responsible for the study design, quality assessment, drafting of the manuscript, critical review and approval of the final manuscript. MRS was responsible for the study design, drafting of the manuscript, critical review and approval of the final manuscript. LMRJ was responsible for the study screening and selection and approval of the final manuscript.

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Correspondence to Adriano Max Moreira Reis.

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Pantuzza, L.L., Ceccato, M.d.G.B., Silveira, M.R. et al. Association between medication regimen complexity and pharmacotherapy adherence: a systematic review. Eur J Clin Pharmacol 73, 1475–1489 (2017). https://doi.org/10.1007/s00228-017-2315-2

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