| Al‐Eidan 2002 | Helicobacter pylori | Intervention patients (n=38) received their medicines via the hospital pharmacy and were counselled (and followed up) by a hospital pharmacist. | Control patients (n=38) were given a standard advice sheet and referred to their GP who prescribed the same therapy. | Yes for improving compliance to a 1‐week course of triple therapy to eradicate H‐pylori. | Yes for improving clinical outcomes for the intervention group who had a significantly higher rate of H‐pylori eradication. |
| Ansah 2001 | Malaria | The use of pre‐packed chloroquine tablets (n=155). | The use of chloroquine syrup (n=144). | Yes. The tablet form of medicine resulted in higher adherence rates, but it isn't established whether this is due to the formulation or the lack of provision of a standard measuring device. | No, there was no difference in the clinical outcomes. |
| Bailey 1990 | Asthma | Pamphlet, workbook, counselling, phone follow‐up, support group, and reinforcement of adherence (n=132) | Instructional pamphlet alone (n=135) | Yes. | Yes. |
| Baird 1984 | Hypertension | Once daily metoprolol (n=196) | Twice daily metoprolol (n=193) | Yes. | No. |
| Becker 1986 | Hypertension | Special "reminder" pill packaging (n=86) | Separate vials for each medication (n=85) | No. | No. |
| Berrien 2004 | HIV | The intervention in intervention group (n=20) consisted of eight structured home visits over a 3‐month period by the same home care experienced registered nurse.
The visits were designed to improve knowledge and understanding of HIV infection, to identify and resolve real and potential barriers to medication adherence, and ultimately to improve adherence. Spanish‐speaking case managers, incentives, notebooks with stickers and pill‐swallowing training were also part of the home visit training sessions. | In the clinic setting for control group (n=17), the physician, nurse and social worker provided standard medication adherence education at clinic appointments generally scheduled at 3‐month intervals. Phone follow‐ups and a single home visit were planned if the staff felt they were needed. Visual aids for remembering medications, medication boxes, beepers, and general technical and emotional support were regularly offered. The clinic nurse contacted the family by telephone when the patient was starting a new medication, was having difficulty with adherence, or needed clarification and support. A single home visit was planned when and if the clinic staff believed medication adherence was poor despite the implementation of the above listed techniques. | Yes for pharmacy report of refill frequency;
no for self‐reported. | No. |
| Brown 1997a | Hyperlipidemia and coronary artery disease | Controlled release niacin bid (n=31) | Regular niacin qid (n=31) | Yes. | Yes. |
| Brus 1998 | Rheumatoid Arthritis | Six patient education meetings. The education programme focused on compliance with sulphasalazine therapy, physical exercises, endurance activities (walking, swimming, bicycling), advice on energy conservation, and joint protection. Four (two hour) meetings were offered during the first months. Reinforcement meetings were given after four and eight months. The programme was implemented in groups and partners were invited to attend the meetings. (n=29) | The control group received a brochure on RA, as provided by the Dutch League against Rheumatism. This brochure gives comprehensive information on medication, physical and occupational therapy. (n=31) | No. | No. |
| Canto De Cetina 2001 | Contraception | 175 received detailed structured pretreatment counseling about the hormonal effects of the injectable. | 175 received routine counseling on duration of use and efficacy of the method. | Yes for the cumulative termination rates. | Yes for the cumulative termination rates. |
| Chaplin 1998 | Schizophrenia | Individual semi‐structured educational sessions discussing the benefits and adverse effects of antipsychotic drugs, including tardive dyskinesia (n=28). | Usual care (n=28). | No. | No. |
| Colcher 1972 | Strep throat | Special counselling and written instructions on need to take all pills (n=100) | Usual care (n=100) | Yes. | Yes. |
| Cote 1997 | Asthma | Extensive asthma education program plus written self‐managed action plan based on PEF (n=50) or based on asthma symptom monitoring (n=45) | Basic information provided plus verbal action plan could be given by physician (n=54) | No for each intervention. | No for each intervention. |
| Cote 2001 | Asthma | Patients in Group Limited Education (LE) (n=30) were given a self‐action plan that was explained by the on call physician. The action plan used "traffic lights" (green, yellow, red) to describe specific states of asthma control based on Peak Expiratory Flow and symptoms and actions that the patient should take for each state. Subjects were all instructed by a respiratory therapist or study nurse in the proper use of an inhaler. In addition to what patients in Group LE received, the patients in Group Structured Education (SE n=33) participated in a structured asthma educational program based on the PRECEDE model of health education within 2 weeks after their randomization. | The patients in Group C (control, n = 35) received the usual treatment given for an acute asthma exacerbation. | No. | No. |
| Coull 2004 | Ischaemic heart disease | Intervention consisted of participation in a mentor‐led group (n=165), through attending monthly 2 hour long meetings in community facilities over a 1‐year period. There was an average of 10 patients per group, each led by two mentors. The core activities covered in the programme were lifestyle risk factors of smoking, diet and exercise; blood pressure and cholesterol; understanding of and ability to cope with IHD; and drug concordance. Each mentored group was also encouraged to develop its own
agenda. Input was provided from a pharmacist, cardiac rehabilitation specialist nurse, dietician, welfare benefits advisor and Recreation Services. Volunteer lay health mentors, aged 54‐74 recruited from the local community led the groups. | Both intervention and control groups (n=154) continued to receive standard care. | Yes. | No. |
| Farber 2004 | Asthma | Subjects in the intervention group (n=28) received basic asthma education; instructions on use of a metered‐dose inhaler with holding chamber; a written asthma self‐management plan illustrated by zones colored green, yellow, and red; a sample age‐appropriate holding chamber; and prescriptions for medication needed to implement the plan. This medication included an inhaled corticosteroid drug for everyday use and a quick‐acting bronchodilator for use as needed. The importance of seeking urgent medical care in the red zone was emphasized. Three brief followup phone calls were placed to patients in the intervention group at 1‐2 weeks, 4‐6 week and 3 months after enrollment. | The control group (n=28) received routine care. | Yes (based on dispensing). | No. |
| Friedman 1996 | Hypertension | Telephone‐linked computer system (TLC) ‐ an interactive computer‐based telecommunications system that converses with patients in their homes between office visits to their physicians (n=156). | Regular medical care (n=145). | Yes. | Yes. |
| Gallefoss 1999b | Asthma & COPD | An educational intervention consisting of a specially constructed patient brochure, two 2‐hour group sessions (separate groups for asthmatics and patients with COPD) concentrating on pathophysiology, antiobstructive medication, symptom awareness, treatment plans, and physiotherapy. One or two 40‐min individual sessions were supplied by both a nurse and a physiotherapist. At the final teaching the patients received an individual treatment plan on the basis of the acquired personal information and 2 weeks of peak flow monitoring (n=39 asthmatics, n=32 COPD patients). | Usual care from GP (n=39 asthmatics, n=32 COPD patients). | No. | No. |
| Gani 2001 | Seasonal rhinitis and asthma | B group (n=35) with drug therapy plus training on the use of nasal spray, and C group (n=36)
the same as B plus a lesson on rhinitis and asthma. | A group (n=30) with drug therapy alone. | Yes for A versus B+C | Yes: between group A and group C in respiratory symptoms.
Yes, in the use of inhaled albuterol (Fisher test) among the groups was observed (A versus B plus C: P=0.005; A versus C: P=0.005). |
| Ginde 2003 | Macrolide antibiotic treatment | Patients in the ED group (n=38) were provided a full course of azithromycin (6 X 250 mg) at no charge and given instructions on the proper dose and frequency before discharge
from the ED. | Patients in the pharmacy group (n=36) received a written prescription for a full course of azithromycin before discharge from the ED. | No. | No. The Rx filling rate for the control group is based on the assumption that control patients used a participating pharmacy 8 blocks away that provided the drugs free of charge ‐ patients were apparently not asked if they filled their prescription elsewhere. The "course completed" rate is based on self report on a telephone call ‐ no indication that interviewers were blinded to group; nor was the exact question given (if there was one). Technically, this study qualified for the review, but the reliability and credibility of the measures are suspect. At least the question of the control group's filling of prescriptions could have been cleared up. The intervention is also impractical in any setting where giving drugs out for free isn't possible. |
| Girvin 1999 | Hypertension | Enalapril 20mg od (n=27). Cross‐over study, with 4 week study periods. | Enalapril 10mg bid (n=27). Cross‐over study. | Yes. | No. |
| Haynes 1976 | Hypertension | Tailoring, self‐monitoring of pills and blood pressure, rewards for higher adherence and lower blood pressure (n=20). | Usual care (n=18). | Yes. | No. |
| Henry 1999 | H. Pylori infection | 10 days of omeprazole 20mg bd, amoxicillin 500mg tds and metronidazole 400 mg tds, verbal advice on medication use and its possible side effects in an initial 20 minute consultation. Patients also received medication in dose‐dispensing units, an information sheet on H. Pylori treatment, and a medication chart. Compliance in intervention group patients was also encouraged by a phone call 2 days after the start of therapy (n = 60). | 10 days of omeprazole 20mg bd, amoxicillin 500mg tds and metronidazole 400 mg tds, verbal advice on medication use and its possible side effects in an initial 20 minute consultation. (n=59) | No. | No. |
| Hill 2001 | Rheumatoid arthritis | The intervention group (n=51) received 7 x 30 minute one to one sessions of patient education. | The control group (n=49) received standard management. | Yes for improving adherence to DPA for rheumatoid arthritis. | No for improving clinical outcomes of plasma viscosity, c‐reactive protein, articular index, morning stiffness and pain score. |
| Howland 1990 | Acute infections | Warnings about potential adverse effects of drugs (n=50). | No warnings about adverse effects of drugs (n=48). | No. | No. |
| Johnson 1978 | Hypertension | (a). Self‐monitoring of blood pressure at home (n=34).
(b). Monthly home visits by a research assistant (n=33).
(c). Both a and b (n=35). | Neither intervention (n=34). | No for each intervention. | No for each intervention. |
| Katon 2001 | Depression | Patient education, 2 visits with a depression specialist, telephone monitoring and follow‐up (n= 194) | Usual care (n=192) | Yes | Yes for SCL‐20 scores and depressive symptomsNo for episodes of relapse/recurrence |
| Kemp 1996 | Acute psychosis. | 4‐6 session compliance therapy that focused on illness, conceptualisation of the problem, symptoms, side effects of treatment, and the stigma of drug treatment (n=25) | 4‐6 session nonspecific counselling (n=22) | Yes. | Yes for global functioning assessment.
Yes for full version of the brief psychiatric rating scale.
No for the abridged version of the brief psychiatric rating scale.
No for dose of antipsychotic drug. |
| Kemp 1998 | Psychotic disorders | 4‐6 session compliance therapy that focused on illness, conceptualisation of the problem, symptoms, side effects of treatment, and the stigma of drug treatment (n=39) | 4‐6 session nonspecific counselling (n=35) | Yes, at 12 months. | No, at 12 months, for the 7‐item version of the Brief Psychiatric Rating Scale.
Yes, at 12 months, for the Global Assessment of Function.
Yes, at 6 months, for the Schedule for Assessment of Insight. |
| Knobel 1999 | HIV | Zidovudine + lamivudine + indinavir PLUS individualised counselling/assessments which consisted of adaptation of treatment to the patient's lifestyle and detailed information about highly active antiretroviral therapy (n=60) | Zidovudine+ lamivudine + indinavir plu conventional care (n=120) | Yes | Yes for reduction of viral load.
No for detectable viral load. |
| Laporte 2003 | Compliance and stability of INR of two oral anticoagulants with different half‐lives | The standard education group received the minimum information consistent with ethical OAT with no particular emphasis on the necessity of strict compliance. Patients in the intensive education group received information about the causes of anticoagulation instability and the importance of strict adherence. The intensive education group were provided information through visual material, were visited daily by nurses and physicians to repeat some items, and were tested daily about their education. The education, either standard or intensive, was given until hospital discharge. | A 2 by 2 factorial design with patients randomly allocated to warfarin (long half‐life, n=43) or acenocoumarol (short‐half life, n=43) and to either intensive education (n=43) or standard education (n=43). | No. | No. |
| Levy 2000 | Acute Asthma | 1 hour structured asthma consultation with study nurse 2 weeks after entry into study, followed by 2 or more 30 minute consultations at 6‐weekly intervals (n=103). | Usual care (n=108) | Yes for use of inhaled topical steroids and rescue medication for severe attacks. Not statistically significant for use of inhaled topical steroids and rescue medication for mild attacks. | Yes. |
| Ludman 2003 | Depression (The same study as Katon 2001) | | | | |
| MarquezContreras2004 | Hypercholesterolaemia | The Intervention group (IG) of 63 patients received the standard care given to control group, and in addition received a telephone call at 7‐10 days, 2 months, and 4 months. The goal of the intervention was to establish the level of compliance, categorize this as adequate or inadequate, and make recommendations based on that. Level of compliance was determined by comparing the number of pills consumed to the number that should have been consumed (calculated using self‐reported information about the number of pills remaining, number of pills dispensed, and fill date of the prescription). Compliance was defined as taking 80‐110% of the pills that should have been taken thus far. Compliant patients were congratulated and encouraged to continue their good level of compliance as it would lower their risk of heart disease. Noncompliant patients were notified their behavior was considered noncompliant and encouraged to better comply with therapy as it would lower their risk of heart disease. | The control group (CG) of 63 patients, who received the doctor's normal treatment, which included oral information about hypercholesterolemia, advice about its control, brochures about dietary recommendations, 3 month‐long prescriptions for a cholesterol‐lowering medication, and titration of that medication if indicated at 3 months. | Yes. | Yes for the 6‐month decrease in total cholesterol and LDL‐C was significantly different between IG and CG (Table 3). No for the 6‐month decrease in triglycerides and HDL‐C. |
| Merinder 1999 | Schizophrenia | 8‐session psychoeducational programme for schizophrenic patients and their relatives, conducted using a mainly didactic interactive method (n=23) | Usual treatment provided in community psychiatry (n=23). | No. | Yes for knowledge of schizophrenia and for VSSS subscore satisfaction with relatives' involvement. There was also a trend towards reduced BPRS score in intervention group (p=0.07).
No for time to relapse or insight into psychosis or psychosocial function (GAF) |
| Morice 2001 | Asthma | Subsequent visits from the asthma nurse until discharge from hospital (n=35). | 'Routine care' from medical and nursing staff but no further intervention from the asthma nurse (n=30). | No (on the contrary, medication compliance of ß‐agonist inhaler in intervention group was lower than in control group). | No for the total occasions of GP call‐out and re‐admission.
Yes for patients percentage of claiming to have a writing management plan and self‐management. |
| Nazareth 2001 | Complex regimens in the elderly (aged 75 years and older on four or more medicines who had been discharged) | The hospital pharmacist developed discharge plans which gave details of medication and support required by the patient. A copy was given to the patient and to all relevant professionals and carers. This was followed by a domiciliary assessment by a community pharmacist. (n=165) | In the control group, patients were discharged from hospital following standard procedures that included a discharge letter to the general practitioner listing current medications (n=151). | No. | No. |
| O'Donnell 2003 | Schizophrenia | The experimental group (n=28) received 5 sessions of compliance therapy, each session lasting 30‐60 minutes. The sessions covered a review of the patient's illness history, understanding of the illness and his or her ambivalence to treatment, maintenance medication and stigma. Compliance therapy is a cognitive behaviour intervention with techniques adapted from motivational interviewing, other cognitive therapies and psychoeducation. | The control group (n=28) received non‐specific counseling comprising of 5 sessions lasting 30‐60 minutes. | No. | No. |
| Peterson 1984 | Epilepsy | Counselling, leaflet, self‐monitoring of pill taking and seizures, mailed reminders for appointments and missed drugs refills (n=27). | Usual care (n=26). | Yes. | No. |
| Peterson 2004 | Dyslipidemia. | Patients in the intervention group (n=45) were visited at home monthly by a pharmacist, who educated the patients on the goals of lipid‐lowering treatment and the importance of lifestyle issues in dyslipidaemia and compliance with therapy, assessed patients for drug‐related problems, and measured total blood cholesterol levels using point‐of‐care testing. | Patients in the control group (n=49) received standard medical care. There was no further contact with patients in the control group after the initial collection of baseline data, until 6 months had lapsed. At that time, their final total blood cholesterol level was measured, and the current medication regimen and self‐reported
compliance were recorded. | No. | No. |
| Peveler 1999 | Depression | Treatment information leaflet (n=53), drug counseling (n=52) or both leaflet and counseling (n=53) | Usual care (n=55) | Yes for counseling (at 12 weeks)
No for leaflet | No for counseling
No for leaflet |
| Piette 2000 | Diabetes | Automated telephone assessment and self‐care education calls with nurse follow‐up (n=137) | Usual care (n=143) | Yes. | Yes. |
| Pradier 2003 | HIV | Patients (n=100) in the intervention group (IG) were offered three individual sessions by trained nurses. | No mention was made of the care that was provided for the control group (n=102). | Yes | No. The clinical significance of these findings is unclear ‐ adherence rate was on self‐report in an unblinded trial, the mean HIV RNA was no different at 6 months for the 2 groups and no actual clinical outcomes were reported. |
| Ran 2003 | Schizophrenia | Family education sessions monthly (FIG, n=127). A second group received meds only (MG, n=105). | Usual care (CG, n=115). | Yes for FIG versus both other groups | Yes for relapse rate for FIG versus other groups. FIG and MG both better than control for symptoms. |
| Rawlings 2003 | HIV | 4 modules of the Tools for Health and Empowerment HIV education intervention (EI) plus routine counseling (RC) (EI + RC; n = 96) | Routine counseling alone (RC; n = 99). | No. | No. |
| Razali 2000 | Schizophrenia | Culturally modified family therapy (CMFT), which consists of a sociocultural approach of family education, drug intervention programme and problem‐solving skills (n=80). | Behavior Family Therapy (BFT) (n=86) | Yes | No at 6 months.
Yes at 12 months for all variables (Exacerbation, GAF score, SBS score, Rehospitalization, Family Burden). |
| Sackett 1975 | Hypertension | (a). Care at worksite by occupational health physicians (n=37)
(b). Detailed 'programmed' instructions about hypertention and adherence (n=28)
(c). Both a and b (n=44) | Neither intervention (n=25)*
* numbers provided by author | No. | No. |
| Schaffer 2004 | Asthma | (a). Audiotape alone (n=10)
(b). National Heart Lung and Blood Institute (NHLBI) booklet alone (n=12)
(c). Audiotape plus NHLBI booklet (n=11). | Standard provider education (control) (n=13) | Yes for positive effect on adherence by pharmacy‐refill measure for booklet vs control, and for booklet + audiotape versus control, but not for audiotape versus control, at 6 months.
No for self‐reported adherence. | No. |
| Stevens 2002 | Helicobacter pylori | A longer adherence counseling session and a follow‐up phone call from the pharmacist during drug treatment (n=163). All subjects were given the same 7‐day course of omeprazole, bismuth subsalicylate, metronidazole, and tetracycline hydrochloride (OBMT). | A standard antibiotic regimen and randomly assigned to receive usual‐care counseling from a pharmacist (n=162). All subjects were given the same 7‐day course of omeprazole, bismuth subsalicylate, metronidazole, and tetracycline hydrochloride (OBMT). | No. | No. (The big problems with this study are that a) both groups got blister packs with daily doses clearly marked; b) both groups got counseling, although this was longer and more detailed for the IC than CG; c) self‐report was used for measuring adherence (insensitive). All these factors would bias towards no difference. ) |
| Strang 1981 | Schizophrenia | Family therapy (n=17). | Individual supportive therapy (n=15). | Yes. | Yes. |
| Tuldra 2000 | HIV | Psychoeducative intervention to implement adherence i.e. explanations about reasons for starting treatment and the relevance of appropriate adherence, development of a dosage schedule with patients' input, patients were taught how to manage various other aspects of medication taking in HAART (i.e. forgetting, side effects, changes in daily routine). Phone number was given should patients have any questions before next interview. Verbal reinforcement of adherence at follow‐up visits (n=55). | Usual medical follow‐up (n=61) | No. | No. |
| van Es 2001 | Asthma | Usual care + pediatrician discussed "asthma management zone system" with participants + pediatrician discussed PEF readings from prior 2 weeks + 4 individual sessions with the asthma nurse + 3 educational group sessions with asthma nurse (n= 58). | Usual care ‐ pediatrician every 4 months (n=54). | No at T1 (12 months).
Yes for self‐reported adherence at T2 (24 months) (but follow‐up was only 77% at this time, so doesn't count). | No. |
| Volume 2001 | Ambulatory elderly (> or = 65 years of age) | Pharmacists (in n=8 pharmacies, 159 patients) used the Pharmacist's Management of Drug‐Related Problems (PMDRP) instrument to summarize the information collected during the patient interview and the subjective, objective, assessment, and plan record to document actions and follow‐up. | Pharmacists at control pharmacies (n=8 pharmacies, 204 patients) continued to provide traditional pharmacy care. | No. | No. |
| Von Korff 2003 | Depression (The same study as Katon 2001) | | | | |
| Walley 2001 | Tuberculosis | 170 were assigned DOTS with direct observation of treatment by health workers; 165 were assigned DOTS with direct observation of treatment by family members. | 162 were assigned self‐administered treatment. | No. | No. |
| Weber 2004 | Intervention group participants received cognitive behavior therapy in addition to usual care. | Participants were randomly assigned to a psychotherapist and given the contact information to schedule their own first appointment. Protocol defined a minimum of three and a maximum of 25 sessions within the 1‐year study period. Participant and psychotherapist determined the frequency of appointments and set their own goals for future interventions. Intervention group participants (n=32) received cognitive behavior therapy in addition to usual care, while control group participants (n=28) received usual care alone. | Both intervention and control groups continued to receive standard care. Standard care included monthly visits for 12 months with assessments of clinical and laboratory data, course of treatment, drug adverse events and HIV‐1 RNA. | No. | No. |
| Weinberger 2002 | Asthma or chronic obstructive pulmonary disease (COPD) | The pharmaceutical care program (n = 447) provided pharmacists with recent patient‐specific clinical data (peak expiratory flow rates [PEFRs], emergency department [ED] visits, hospitalizations, and medication compliance), training, customized patient educational materials, and resources to facilitate program implementation. | The PEFR monitoring control group (n = 363) received a peak flow meter, instructions about its use, and monthly calls to elicit PEFRs. However, PEFR data were not provided to the pharmacist. Patients in the usual care group (n = 303) received neither peak flow meters nor instructions in their use; during monthly telephone interviews, PEFR rates were not elicited. Pharmacists in both control groups had a training session but received no components of the pharmaceutical care intervention. | Yes, for within‐group at 6 and 12 months; no for between‐group | Yes. At 12 months, patients receiving pharmaceutical care had significantly higher peak flow rates than the usual care group (P =0.02) but not than PEFR monitoring controls (P =0.28). There were no significant between‐group differences in HRQOL, but patients participating in our program were significantly more satisfied with their pharmacists than the other two groups. |
| Wysocki 2001 | Diabetes | Behavioral‐Family Systems Therapy (BFST) ‐10 sessions consisting of 4 therapy components: problem solving training, communication skills training, cognitive restructuring and functional and structural family therapy, plus $100 monetary incentive for attending all 10 intervention sessions. (n=38). Education and Support (ES) ‐ families attended 10 group diabetes education and social support meetings (45 minute educational presentation by diabetes professional + 45 min interaction among the families), plus $100 monetary incentive for attending all 10 intervention sessions (n=40). | Current Therapy (n=41) ‐ standard pediatric endocrinology follow‐up and self‐management training. | No for BFST and ES at posttreatmentYes for BFST at 6 and 12‐monthsNo for ES at 6 and 12‐months | No for BFST in diabetic control or adjustment to diabetes. Yes for BFST on PARQ scales at posttreatment, 6 and 12 months. No for ES. |
| Xiong 1994 | Schizophrenia | Family counselling and close follow‐up (n=34). | Prescription of medication without formal follow‐up (n=29). | No. | Yes. |
| Zhang 1994 | Schizophrenia | Family intervention (n=42). | Prescription of medication without formal follow‐up (n=41). | No. | Yes. |
