THE METHODOLOGICAL QUALITY AND EFFECTIVENESS OF ADHERENCE INTERVENTIONS- A REVIEW OF DIABETES TYPE II INTERVENTIONS

Author(s)

Wilke T1, Mueller S2, Groth A11Institute for Pharmacoeconomics and Drug Logistics, University of Wismar, Wismar, Germany, 2University of Wismar, Wismar, Germany

OBJECTIVES: Adherence interventions (AI) are an important part of the health care provision situation on the ground. For ethical, clinical and health economic reasons, it is vital to identify methodological characteristics of successful AI. The aim of this review is to do this for AI focused on oral anti-diabetics (Diabetes type II). METHODS: A comprehensive review of Diabetes type II AI effectiveness studies was conducted [Strings: (oral hypoglycemic agents; oral anti-diabetic medications; diabetes; hyperglycemia; Biguanide; Metformin; Potassium channel inhibitors; Dipeptidyl peptidase-4 inhibitors) and (improvement; enhancement; pharmacy, pharmacist; doctors; interventions; programs; reminder; prevention; patient education)]. Only interventions aiming to improve medication adherence/persistence were included. RESULTS: A total of 6977 contributions were identified; after detailed examination by two reviewers 15 publications evaluating 19 different AI were included. 10 AI were able to improve the adherence/persistence and 8 were able to improve the blood glucose levels of patients (double counting in 3 cases); 5 had no effect at all. Four dimensions of the methodological quality of AI programs were identified: 1) measurement of adherence/persistence/clinical outcomes, 2) measurement of NA/NP causes, 3) use of effective/validated intervention measures; and 4) effective program evaluation. The authors defined 5 detailed methodological requirements per dimension and, based on this, developed a corresponding scoring model (MIN Score 0, MAX score 20). All 19 AI programs were evaluated in the scoring model (average score 8.05): • Score<5: 3 AI – no adherence/blood glucose level improvement; • Score 5-9: 8 AI – 6 with improvement in both adherence and/or blood glucose levels • Score >9: 8 AI – all improved adherence and/or blood glucose levels. CONCLUSIONS: The scoring model provides a starting point for the methodical evaluation of AI. However, further development and testing of both the elements and construction is needed for medical indications other than diabetes type II.

Conference/Value in Health Info

2010-11, ISPOR Europe 2010, Prague, Czech Republic

Value in Health, Vol. 13, No. 7 (November 2010)

Code

PDB65

Topic

Patient-Centered Research

Topic Subcategory

Adherence, Persistence, & Compliance

Disease

Diabetes/Endocrine/Metabolic Disorders

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