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