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Electronic monitoring of patient adherence to oral antihypertensive medical treatment: a systematic review.
Christensen A, Osterberg LG, Hansen EH. Electronic monitoring of patient adherence to oral antihypertensive medical treatment: a systematic review. Journal of Hypertension 2009 27 (8):1540-51. [PubMed]
Sources of funding: Bang & Olufsen Medicom A/S and the Danish Ministry of Science, Technology and Innovation. No perceived conflict of interest.
Main author affiliation: Hansen EH, Section for Social Pharmacy, Department for Pharmacology and Pharmacotherapy, Faculty of Pharmaceutical Sciences, University of Copenhagen, Copenhagen, Denmark.
Q: What is the impact of electronic monitoring on patient adherence to self-administered oral antihypertensive medications?
Electronic monitoring devices, which records the removal of medication doses from their containers, have been implemented since research has shown that the most widely used methods of assessing adherence (pill counts, patient interviews, pharmacy refills and assessment by treatment physician) repeatedly overestimate adherence. The objective of the current review was to evaluate the effectiveness of electronic monitoring of patient adherence to self-administered oral antihypertensive medications.
Individual studies from systematic review
SEARCH FOR EVIDENCE: Up to January 2009
INCLUDED STUDIES: 53 studies (62 papers)
STUDIES RELATED TO PRESCRIBING: 5
STUDY DESIGN: BA, RCT, Other.
- Target Population: Pharmacists, Physicians.
- Intervention(s): Patient-mediated, Revision of professional roles — nursing.
- Setting: Outpatient clinics, Pharmacies, Primary care practices; Ownership — public, Ownership — not specified/unclear; Academic — not specified/unclear.
- Patients Reviewed: Age: Not specified/unclear; Diagnosis/clinical condition: Patients on antihypertensive medications.
- Drug Related Outcome Categories: Concordance.
- Other Outcome Categories: None.
AUTHORS' ANALYSIS OF DATA:
Vote counting based on direction of effect.
REVIEW QUALITY: 5
RESULTS - OVERALL
RESULTS - RELATED TO PRESCRIBING
Of the 53 studies included in this review, 32 were RCTs. Concordance outcomes were found to improve with patient-mediated interventions (n=4), but there was insufficient evidence examining the effect of the expansion of nursing roles on this outcome. Forty of the included studies were excluded from our analysis as they were beyond the scope of this project. One study was excluded because it reported the results of a case study.
CONCLUSIONS - OVERALL
CONCLUSIONS - RELATED TO PRESCRIBING
Medium quality review. Too few studies were located to make conclusions on prescribing related outcomes.
Table of Results
|Patient-mediated vs control||Appropriate use||4||Vote counting based on direction of effect||Concordance:
Vote counting 3/4 RCTs favoured intervention: generally effective.
|Revision of professional roles — nursing vs control||Appropriate use||1||Vote counting based on direction of effect||Concordance:
Vote counting 0/1 RCT favoured intervention: insufficient evidence.