Interventions Strategies for Improving Medication Adherence
Ten of the 36 included studies have evaluated the effectiveness of
various interventions to improve medication adherence among patients
diagnosed with MDD as presented in Table 6. Since adherence was related
to health outcomes, medication adherence enhancing interventions should
design and implement that can reflect in increase the number of patients
who adhere to medication. These
have ranged from single element interventions and through to
multi-element intervention packages. These interventions have been
categorized into counseling
(cognitive, behavioral interventions),
education and information,
reminders, monitor feedback (adherence and disease), and multi-faceted
intervention. Multi-faceted
interventions defined as intervention including two or more components
such as education with monitor feedback, and cognitive education with
counselling.75 Out of 10 studies, five randomized
controlled studies, one cluster randomized trial study, one randomized
controlled trial with two parallel-group posttest-only study, one
pre-post one-group intervention study, one observational
retrospective cohort study, and
one prospective nonrandomized open-label naturalistic observational
study.
In two studies the intervention was delivered as integrated service in
primary health centers by pharmacists and pharmacy students to examine
intervention,49,67 other study was delivered enhanced
care home visits in primary health centers after the first medical
consultation by community health workers.72 Hammonds
et al71 used electronic medication reminder
application through a smartphone device to enhance adherence to AD
medications and evaluated after about 35 days from the initial
assessment. Also, bibliotherapy and text messaging a novel approach
delivered as counseling (cognitive, behavioral interventions) developed
by psychologists, psychiatrists, and community medicine
specialists.61 Five studies were provided the
intervention from 1 to 4 sessions to patients by pharmacists,
psychiatrist, physicians, social workers, nurses, and candidate master
degree researcher.19,47,54,62,68
Interventions Based on Monitored Adherence Feedback.The use of pharmacy management
service and community healthcare service has been shown to have positive
effects on medication adherence.49,67 Pharmacist-led
multidisciplinary AD telemonitoring service provided monitoring of
patients for early interventions following AD initiation or up-titration
to enhance adherence, relieve adverse effects, and minimize suicide
risks through education and information and monitor feedback (adherence
and disease).49 Also, community pharmacists (CPs)
management which used education and information, reminders, and monitor
feedback (adherence and disease) approach, compared CP management with
treatment-as-usual (TAU) after 1 and 6-months AD treatment adherence
rate was high among patients received CP management.67Other study was delivered enhanced care home visits as education and
information and monitor feedback (adherence and disease) in primary
health centers after the first medical consultation by community health
workers. The enhanced care home visits group as a treatment intervention
(TI) showed a significant completed the treatment and treatment
adherence compared with the treatment as usual (TAU) group. However,
there was no significant difference in the outcomes of depression at six
months follow up.72
Interventions Based on Reminder Systems. Use of electronic
medication reminder application increase adherence to AD
medications.71 Electronic medication reminder
application via smartphone for about 35 days in a randomized,
parallel-group clinical trial enhance adherence to AD medications in
college students.71
Education and Information Interventions. The use of information
in a different form of delivery, verbal, written, or audiovisual. These
interventions are designed to educate patients to promote medication
adherence and motivate patients by sufficiently describing the way of
taking medication, producing and discussing with patients any reluctance
to take medication, and discussing with patients their beliefs and
knowledge about their condition and treatments.47,68This intervention focuses on patients, context, and health care system,
which adopting patient-centered care and sharing decision-making
principles.47,68 Providing information about AD
medications by pharmacist interventions, it significantly improves
medication adherence, treatment satisfaction, general overuse beliefs,
and specific concern beliefs. However, the severity of depression and
health-related quality of life did not make a difference between the
interventional and control group after six months.47However, other studies used depression medication choice as a novel
shared decision-making approach, compared with usual care found that no
difference in medication adherence, depression control, or encounter
duration.68
Cognitive-Behavioral Counseling Interventions.Cognitive-behavioral therapy (CBT), as a new discovery, which is being
applied in the field of psychotherapy, has proven effective in
improvements in self-concept, pessimistic worldview, negative thoughts,
and medication adherence.32 The use of a novel
approach of cognitive-behavioral interventions through bibliotherapy
(booklet) and text messaging by allocated to three groups, control,
booklet, and booklet and text messaging. The data collected three times:
before the intervention, immediately after intervention, and three
months after intervention. Medication adherence insignificant within
each group at different times, while it was statistically significant in
the interactive effect of group factor and the time
factor.61
Multi-Faceted Intervention. A single element approach has
limited effectiveness on medication adherence because the factors
determining adherence interact and potentiate each other’s
influence.3,32 On the other hand, adequate evidence
has been supporting that multi-faceted most effective approach, which
targets more than one factor by more than one strategy. Several
programmers have demonstrated effective outcomes using a multi-elements
approach.19,54,62 Examples include the treatment
initiation and participation program (TIP), drug adherence enhancement
program, and psychoeducation with basic CBT
strategies.19,54,62 Particularly, multi-elements
approach significantly improvements in the knowledge of depression,
attitude towards medication adherence, and reductions in depressive
symptoms compared with TAU.19,54,62
Furthermore, the use of pharmacy management service and community
healthcare service as a multi-faceted approach has been shown to have
positive effects on medication adherence.49,67,72Pharmacist-led multidisciplinary AD telemonitoring service provided
monitoring of patients for early interventions following AD initiation
or up-titration to enhance adherence, relieve adverse effects, and
minimize suicide risks through education and information and monitor
feedback (adherence and disease).49 Also, community
pharmacists (CPs) management which used education and information,
reminders, and monitor feedback (adherence and disease) approach,
compared CP management with treatment-as-usual (TAU) after 1- and
6-months AD treatment adherence rate was high among patients received CP
management.67 Other study was delivered enhanced care
home visits as education and information and monitor feedback (adherence
and disease) in primary health centers after the first medical
consultation by community health workers. The enhanced care home visits
group as a treatment intervention (TI) showed a significant completed
the treatment and treatment adherence compared with the treatment as
usual (TAU) group. However, there was no significant difference in the
outcomes of depression at six months follow up.72