Rebecca Ryan|Nancy Santesso|Dianne Lowe|Sophie Hill|Jeremy Grimshaw|Megan Prictor|Caroline C. Kaufman|Genevieve Cowie|Michael Taylor
Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews
La Trobe University|McMaster University|La Trobe University|La Trobe University|Ottawa Hospital|University of Melbourne|Austin Regional Clinic|La Trobe University|Australian Catholic University
many systematic reviews exist interventions improve safe effective medicines use consumers research distributed across diseases populations settings scope focus reviews also vary widely creating challenges decisionmakers seeking inform decisions using evidence consumers medicines usethis update 2011 overview systematic reviews synthesises evidence irrespective disease medicine type population setting effectiveness interventions improve consumers medicines useto assess effects interventions target healthcare consumers promote safe effective medicines use synthesising reviewlevel evidencewe included systematic reviews published cochrane database systematic reviews database abstracts reviews effects identified relevant reviews handsearching databases start dates march 2012we screened ranked reviews based relevance consumers medicines use using criteria developed overviewwe used standardised forms extract data assessed reviews methodological quality using amstar tool used standardised language summarise results within across reviews gave bottomline statements intervention effectiveness two review authors screened selected reviews extracted analysed data used taxonomy interventions categorise reviews guide syntheseswe included 75 systematic reviews varied methodological quality reviews assessed interventions diverse aims including support behaviour change risk minimisation skills acquisition reviews aimed promote systemslevel consumer participation medicinesrelated activities medicines adherence frequentlyreported outcome others knowledge clinical serviceuse outcomes also reported adverse events less commonly identified associated interventions costs rarely reportedlooking across reviews outcomes medicines selfmonitoring selfmanagement programmes appear generally effective improve medicines use adherence adverse events clinical outcomes reduce mortality people selfmanaging antithrombotic therapy however participants unable complete interventions suggesting may suitable everyoneother promising interventions improve adherence key medicinesuse outcomes require investigation certain effects include simplified dosing regimens positive effects adherence interventions involving pharmacists medicines management medicines reviews positive effects adherence use medicines problems clinical outcomes pharmaceutical care services consultation pharmacist patient resolve medicines problems develop care plan provide followup positive effects adherence knowledgeseveral strategies showed positive effects particularly relating adherence outcomes effects less consistent overall need study included delayed antibiotic prescriptions effective decrease antibiotic use mixed effects clinical outcomes adverse effects satisfaction practical strategies like reminders cues andor organisers reminder packaging material incentives positive although somewhat mixed effects adherence education delivered selfmanagement skills training counselling support training enhanced followup information counselling delivered together educationinformation part pharmacistdelivered packages care positive effects adherence medicines use clinical outcomes knowledge mixed effects studies financial incentives positive mixed effects adherenceseveral strategies also showed promise promoting immunisation uptake require study certain effects included organisational interventions reminders recall financial incentives home visits free vaccination lay health worker interventions facilitators working physicians promote immunisation uptake education andor information strategies also showed positive even less consistent effects immunisation uptake need assessment effectiveness investigation heterogeneitythere many different potential pathways consumers use medicines could targeted improve outcomes simple interventions may effective complex strategies however single intervention assessed effective improve medicinesuse outcomes across diseases medicines populations settingseven interventions showed promise assembled evidence often provided part picture example simplified dosing regimens seem effective improving adherence yet sufficient information identify optimal regimenin instances interventions appear ineffective example evidence suggests directly observed therapy may generally ineffective improving treatment completion adherence clinical outcomesin cases interventions may variable effects across outcomes example strategies providing information education single interventions appear ineffective improve medicines adherence clinical outcomes may effective improve knowledge important outcome promoting consumers informed medicines choicesdespite doubling number reviews included updated overview uncertainty still exists effectiveness many interventions evidence works remains sparse several populations including children young people carers people multimorbiditythis overview presents evidence 75 reviews synthesised trials studies evaluating effects interventions improve consumers medicines usesystematically assembling evidence across reviews allows identification effective promising interventions improve consumers medicines use well evidence indicates ineffectiveness uncertaintydecision makers faced implementing interventions improve consumers medicines use use overview inform decisions interventions may promising improve particular outcomes intervention taxonomy may also assist people consider strategies available relation specific purposes example gaining skills involved decision making researchers funders use overview identify research needed assess priority limitations available literature due lack evidence important outcomes important populations people multimorbidity also considered practice policy decisions