A critical review of interventions to increase compliance with medication-taking, obtaining medication refills, and appointment-keeping in the treatment of cardiovascular disease

Background. The aim of this study was to critically review the literature regarding interventions to improve cardiovascular patients' compliance with medication-taking, obtaining medication refills, or appointment keeping. Methods. The search for relevant randomized trials involved searching the Medline, Healthplan, and Psychlit databases from 1985 to 1996; searching the bibliographies of located studies; contacting Australian government departments, nongovernment organizations, and pharmaceutical companies; and ultimate review of the resulting list by two field experts. The 33 located trials were critically appraised and classified as being of good, fair, or poor methodological quality. Descriptive and effectiveness data were then extracted from the 20 good and fair quality trials. Interrater reliability was high on the 20% of references double-coded. Results. The 20 studies reviewed evaluated the effectiveness of 18 intervention strategies. Tentative recommendations were made for many patient-focused and structural strategies across all three target behaviors. Physician-focused strategies, tested only for appointment keeping, were all tentatively recommended against. Conclusions. The methodological quality of many of the located trials was less than optimal, prohibiting strong recommendations. Therefore, further good-quality, randomized trials are necessary in order to clarify the effectiveness of those strategies identified as potentially useful in this review, (C) 1999 American Health Foundation and Academic Press.