A systematic review of interventions to improve adherence to diabetes medications within the patient-practitioner interaction

• Objectives: To conduct a systematic review of the literature examining interventions delivered by health care practitioners to improve medication adherence in patients with diabetes mellitus (DM). • Methods: Databases were searched up to 2 July 2013 to identify eligible studies that included interventions that were conducted in a clinic-based setting and delivered by a health care practitioner (eg, nurse, physician, diabetes educator) to improve adherence to diabetes medications (including oral hypoglycemic agents and insulin). Articles were limited to published clinical trials conducted in adults ≥ 18 years of age and published in English-language journals. • Results: 18 papers were reviewed: 15 trials targeted patients with DM, 3 targeted health care practitioners. 7 patient-focused and 1 practitioner-focused trial demonstrated a beneficial effect of the intervention compared with a control group. The patient-focused trials were complex interventions involving a combination of adherence-enhancing strategies such as individualized patient counseling, tailored patient education, medication reminders, behavioral feedback and reinforcement, and care management by ancillary staff, nurses, text message or telephone-linked system. The practitioner-focused trial employed an electronic feedback system for individualized care and quality improvement. Limitations included the diversity in the measures employed to assess adherence; differing definitions of adherence; the inclusion of patients regardless of baseline adherence status; and the short duration of the trials. • Conclusions: Additional research is needed to understand the conditions under which interventions targeting the patient-practitioner interaction can be implemented in clinic settings to improve medication adherence in patients with DM.