Ovidiu Teofil Tatar (2014). A Mixed Methods Systematic Review of the Barriers and Facilitators of Medication Regimen Adherence in Primary Care Patients with Alzheimer’s Dementia and Related Disorders McGill Family Medicine Studies Online, 09: e03.

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ABSTRACT

Background: The prevalence of Alzheimer’s disease and related disorders (ADR) is increasing worldwide due to population aging. It is estimated that one in five baby boomers will be affected. These patients, often treated in primary care, frequently have numerous co-morbidities which require complex medication regimens. Adherence to medications in these patients is poor with important effects on disease outcomes. The adherence to medications is influenced by multiple factors and has been synthesized in frameworks of adherence, but these are either not dementia specific, or not comprehensive enough, or lack information about the impact of identified factors on adherence. Objectives: To develop a comprehensive and dementia specific framework on adherence to any prescription medications and to synthesize the influence of factors on adherence to medications.

Methods: We did mixed methods systematic review of qualitative, quantitative and mixed methods studies published in MEDLINE, PsycINFO, EMBASE, and CINAHL up to October 2013. In the first phase, qualitative evidence was synthesized through an inductive-deductive thematic analysis; a comprehensive and dementia specific framework was thus proposed. In the second phase, based on the new framework, a narrative synthesis of the influence of identified factors was provided. In the third phase, through integrating the output of the first and second phases, a synthesis of the direction of influence of factors of adherence to any prescription medications was provided.

Results: From 4560 references, we retained 34 articles of the following designs: 26 quantitative, 6 qualitative and 2 mixed methods studies. Factors of medication adherence to any prescription medications can be categorized in five categories: patient factors, caregiver factors, patient and caregiver factors, prescriber and other healthcare professional (such as nurses and pharmacists) factors (labeled as prescriber for the rest of the thesis) and healthcare system factors. Two sub-categories of factors have major importance for patients, caregivers and prescribers: “behavioral” and “treatment and support”. For each sub-category, a list of specific factors was provided. The influence of specific factors on adherence was organized as: possible barriers, possible facilitators, factors with no impact, factors for which contradictory evidence exists and factors for which the impact on adherence has not been measured yet.

Conclusions: The comprehensive and dementia specific framework and the direction of influence of specific factors on adherence can inform efficient interventions for increasing adherence to medications. Based on the influence on adherence, suggestions for clinical practice and for future studies are provided.