Transcript Style M 36 by 54 - International Society for

Most Effective Adherence-Enhancing Interventions for Osteoporosis Medications
Mickaël
1 Maastricht
1-2
Hiligsmann ,
Maribel Salas
3,4,
Dyfrig A. Hughes
5,
Elizabeth Manias
6,
Femida H. Gwadry-Sridhar
7,
Pat Linck
5,
Warren Cowell
8
University, Netherlands. 2 University of Liège, Belgium. 3 AstraZeneca, USA. 4 CCEB, University of Pennsylvania, USA 5 Bangor University, United Kingdom. 6 University of Melbourne, Australia. 7
University of Western Ontario, Canada, 8 Bayer, United Kingdom
Introduction
Adherence to osteoporosis medications is
suboptimal with persistence rates of
between 25% and 35% at one year. This
results in higher fracture rates with
significant medical costs and
hospitalizations. Over the past years,
interventions have been proposed to
improve medication adherence. The
objective of this study was to critically
appraise the literature and determine the
most effective adherence-enhancing
interventions for osteoporosis medications.
Materials and Methods
We conducted a literature search using
Medline, EMBASE, Cochrane library and
CINAHL using the following key words:
osteoporosis, low bone density, low bone
mineral density, low bone mass, low bone
turnover, low bone mass density and
bisphosphonates, calcium, colecalciferol,
estrogens, hormone replacement therapy,
raloxifene, vitamin D and patient
compliance, adherence, concordance,
persistence, and interventions, clinical trials,
RCT. The search period was January 1st,
st
1999 to July 31 , 2010. We included studies
on adult users of osteoporosis medications
that evaluated an adherence-enhancing
intervention (e.g. patient education,
intensified patient care), and which reported
quantitative results of adherence. Each
article was reviewed independently by two
investigators and disagreements were
resolved by consensus. Downs’ checklist
was modified to assess the quality of
studies. Since the studies were too
heterogeneous, we focused on a narrative
systematic review.
Results
27 publications were identified
Table 1. Characteristics of Included Studies
including 8 studies which
Reference
Type
of
intervention
Study
design
Sample
size
Followrandomized more than 4,500
Randomization
Use of
Study
Control
up
time
patients fulfilled the inclusion
Comparator
Group
Group
criteria. Articles on reviews (5),
Blalock et al. 2002
Tailored educational program
No
Yes
714
0
12 m
protocols (1), lack of intervention (7) Clowes et al. 2004
Monitoring
Yes
Yes
73
24
1y
or no quantitative data on
Robbins et al. 2004
Educational information by nurses
No
No
109
0
1y
adherence (6) were excluded. The
Delmas
et
al.
2007
Monitoring
and
feedback
on
results
Yes
Yes
2302
1113
1
y
most frequent intervention was
Cook et al. 2007
Telehealth program
No
No
402
0
6m
education (6) followed by
Shu et al. 2009
Physician’s directed education
Yes
Yes
1867
875
10 m
monitoring/supervision (2). Four
studies used randomization, which
Nielsen et al. 2010
Group-based educational program
Yes
Yes
300
150
2y
was led by nurses (3), pharmacists
Ojeda-Bruno et al. 2011 Patient education by nurse/ physician
No
No
380
0
4y
(1), physicians (1) and
multidisciplinary teams (2). Follow-up ranged from 3 to 48 months. The average intervention effect ranged from 12% (education) to 24%
(patients monitored by nursing staff). The average quality score was 65.7%.
Table 2. Results of Included Studies
Identified abstracts = 27
Excluded
Reviews = 5
Protocols = 1
Lack of intervention = 7
No quantitative data on adherence = 6
Studies that fulfilled inclusion criteria = 8
Education = 6
Monitoring/supervision = 2
Flow diagram of Studies
Results of Included Studies
Outcomes
Control
Reference
Blalock et al, 2002
Ca –not
changes
42%
Intervention
for Study
↑ Ca intake
500mg/d
65%
P
value
<0.05
Clowes et al, 2004
Adherence/Calcium (Ca)
intake
Adherence
Robbins et al, 2004
Adherence
81%
87%
<0.05
Delmas et al, 2007
Persistence
77%
80%
0.016
Cook et al, 2007
Adherence
40%
69%
<0.001
Shu et al, 2009
MPR
73%
74%
0.18
Nielsen et al, 2010
Adherence
80%
92%
0.006
Ojeda-Bruno et al, 2011
Adherence/Persistence
16%
71% / 76%
--
0.04
Conclusion
The most effective adherence interventions with osteoporosis medications were in patients monitored by nursing staff and received education.
There is a need to conduct additional research with interventions and to consider the impact of specific pharmacological treatments on
medication adherence.
Acknowledgements
This work was conducted by the Medication Adherence and Persistence SIG from the International Society of Pharmacoeconomics and Outcomes Research
ISPOR 16th Annual International Meeting, May 24, 2011, Baltimore, MD, USA