Interventions to increase adherence to medications for tobacco dependence

Gareth J Hollands; Máirtín S McDermott; Nicola Lindson‐Hawley; Florian Vogt; Amanda Farley; Paul Aveyard

doi:10.1002/14651858.CD009164.pub2

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Figure 1

Study flow diagram

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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1 Primary outcome (adherence), Outcome 1 Adherence ‐ Dichotomous outcomes.

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Analysis 1.2

Comparison 1 Primary outcome (adherence), Outcome 2 Adherence ‐ Continuous outcomes.

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Analysis 2.1

Comparison 2 Secondary outcomes, Outcome 1 Short‐term abstinence < 6 months.

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Analysis 2.2

Comparison 2 Secondary outcomes, Outcome 2 Long‐term abstinence ≥ 6 months.

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Summary of findings for the main comparison. Interventions to increase adherence compared to standard care for improving adherence to medications for tobacco dependence and abstinence from smoking

Interventions to increase adherence compared to standard care for improving adherence to medications for tobacco dependence and abstinence from smoking
Patient or population: Adult smokers Settings: Typically in‐person clinical settings Intervention: Interventions to increase adherence through providing information and facilitating problem‐solving Comparison: Standard care
Outcomes	Relative effect (95% CI)	Illustrative comparative risks (95% CI)		No of Participants (studies)	Quality of the evidence (GRADE)
		Assumed risk	Corresponding risk
		Standard care	Interventions to increase adherence
Adherence to medications for tobacco dependence (dichotomous outcomes)	RR 1.14 (1.02 to 1.28)	Study population		1630 (5 RCTs)	⊕⊕⊕⊝ MODERATE ¹
		368 per 1000 achieve a specified satisfactory level of adherence	419 per 1000 (375 to 471) achieve a specified satisfactory level of adherence
Adherence to medications for tobacco dependence (continuous outcomes)	SMD 0.07 (‐0.03 to 0.17)	The mean level of adherence is 0	The mean level of adherence is 0.07 standard deviations higher (0.03 lower to 0.17 higher)	1529 (4 RCTs)	⊕⊕⊝⊝ LOW ^1,2
Short‐term abstinence from smoking (<6 months)	RR 1.07 (0.95 to 1.21)	Study population		1755 (4 RCTs)	⊕⊕⊝⊝ LOW ^1,3
		363 per 1000 achieve abstinence	389 per 1000 (345 to 439) achieve abstinence
Long‐term abstinence from smoking (≥6 months)	RR 1.16 (1.01 to 1.34)	Study population		3049 (4 RCTs)	⊕⊕⊝⊝ LOW ^1,4
		171 per 1000 achieve abstinence	198 per 1000 (173 to 229) achieve abstinence
The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹All studies are judged to be at high or unclear risk of bias which lowers confidence in estimate of effect ²Includes sufficient sample size for single adequately powered trial but 95% CI overlaps no effect and ranges from very small harm to small benefit ³Includes sufficient sample size for single adequately powered trial but 95% CI overlaps no effect and ranges from small harm to substantial benefit ⁴Substantial heterogeneity with inconsistency in point estimates and limited overlap of confidence intervals

Summary of findings for the main comparison. Interventions to increase adherence compared to standard care for improving adherence to medications for tobacco dependence and abstinence from smoking

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Table 1. Brief descriptions of adherence interventions

Study	Brief description of specific intervention components intended to increase adherence*	Additional contact time relative to standard care?	Medication for which adherence was targeted
Chan 2010	Added counselling contact time to standard behavioural support, focusing specifically on medication adherence	Yes	NRT
Chan 2011	Added counselling contact time to standard behavioural support, focusing specifically on medication adherence	Yes	NRT
Marteau 2012	Tailored and communicated about NRT dosage using a more potent rationale (genotype versus phenotype)	No	NRT
Mooney 2005	Personalised feedback of questionnaire responses regarding medication	No	NRT
Mooney 2007	Personalised feedback of externally validated medication adherence	Yes	Bupropion
Nollen 2011	Added counselling contact time to standard behavioural support, focusing specifically on medication adherence	Yes	Varenicline
Schmitz 2005	Personalised feedback of externally validated medication adherence	Yes	Bupropion
Smith 2013	Added counselling contact time to standard behavioural support, focusing specifically on medication adherence	Yes	NRT
* For further details see Characteristics of Included Studies

Table 1. Brief descriptions of adherence interventions

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Comparison 1. Primary outcome (adherence)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Adherence ‐ Dichotomous outcomes Show forest plot	5	1630	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [1.02, 1.28]

2 Adherence ‐ Continuous outcomes Show forest plot	4	1529	Std. Mean Difference (IV, Fixed, 95% CI)	0.07 [‐0.03, 0.17]

Comparison 1. Primary outcome (adherence)

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Comparison 2. Secondary outcomes

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Short‐term abstinence < 6 months Show forest plot	4	1755	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.95, 1.21]

2 Long‐term abstinence ≥ 6 months Show forest plot	4	3049	Risk Ratio (M‐H, Fixed, 95% CI)	1.16 [1.01, 1.34]

Comparison 2. Secondary outcomes

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