Evaluating the Effectiveness of Remote Behavioral Interventions Facilitated by Health Care Providers at Improving Medication Adherence in Cardiometabolic Conditions: A Systematic Review and Meta-Analysis.


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Article
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Authors
Chilala, Chimweta I  ORCID logo  https://orcid.org/0000-0001-9039-2367
Kassavou, Aikaterini  ORCID logo  https://orcid.org/0000-0002-6562-4143
Sutton, Stephen 
Abstract

BACKGROUND: Although cardiometabolic conditions account for over 32% of all global deaths, nearly half of the patients with cardiometabolic conditions do not take medication as prescribed. Remote behavioral interventions have been shown to potentially improve adherence in these patients and further support cost effective clinical practice. PURPOSE: To evaluate the effectiveness of remote behavioral interventions at improving treatment adherence and to explore behavioral intervention components associated with it. METHODS: We searched MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science in April 2021. Random-effects meta-analyses were utilized. RESULTS: In total, 40 studies, including 24,672 participants, were included. The overall quality of evidence, assessed using the RoB2 tool, was low. The intervention had a small (odds ratios [OR] = 1.70, 95% CI: 1.47, 1.96, N = 4823 p < .001) to moderate effect (SMD = 0.57, 95% CI: 0.38, 0.76, N = 20,271, p < .001) on the dichotomous and continuous outcomes, respectively. Systolic blood pressure (SBP) was reduced by 3.71 mmHg (95% CI: 3.99, 3.43, N = 6,527, p < .001) and participants receiving the intervention were twice more likely to achieve blood pressure (BP) control (OR = 2.14, 95% CI: 1.61, 2.84, N = 1,172, p < .001). Generally, HBA1c decreased by 0.25% (95% CI: 0.33, 0.17, N = 6,734, p < .001), whereas low-density lipoprotein (LDL)-cholesterol dropped by 6.82 mg/dL (95% CI: 8.33, 5.30, N = 4,550, p < .001) in favor of the intervention. There was a trend suggesting a potential positive effects on reducing visits to emergency department (OR=0.76, 95% CI: 0.57, 1.01, N = 4,182) and mortality rates (OR=0.78, 95% CI: 0.42, 1.42, N = 1,971), and no risk for hospital readmission (OR=1.00, 95% CI: 0.83, 1.20, N = 5,402), favoring the intervention. CONCLUSIONS: Despite low quality of evidence, remote consultations are effective at improving medication adherence and clinical indicators, and potentially cost-effective solution for health care services.

Description
Keywords
Cardiometabolic conditions, Interactive remote behavioral interventions, Medication adherence, Remote consultations, Telemedicine, Humans, Medication Adherence, Behavior Therapy, Health Personnel, Cholesterol, Cardiovascular Diseases
Journal Title
Ann Behav Med
Conference Name
Journal ISSN
0883-6612
1532-4796
Volume Title
Publisher
Oxford University Press (OUP)
Sponsorship
National Institute for Health Research (NIHR) (via Cambridgeshire and Peterborough Clinical Commissioning Group (CCG)) (RP-PG-0615-20013)