Using self-reported race and ethnicity for participants in the Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE) trial, Choudhry et al. (2014) found that rates of medication adherence were significantly lower and rates of adverse clinical outcomes were significantly higher for nonwhite patients than for white patients. Providing full drug coverage increased medication adherence in both groups. Among nonwhite patients, it also reduced the rates of major vascular events or revascularization by 35 percent and reduced total health care spending by 70 percent. Providing full coverage had no effect on clinical outcomes and costs for white patients. We conclude that lowering copayments for medications after myocardial infarctions may reduce racial and ethnic disparities for cardiovascular disease.

Choudhry et al. (2017) compared the effect of 3 low-cost reminder devices on medication adherence in a 4-arm, block-randomized clinical trial. Conclusion: Low-cost reminder devices did not improve adherence among nonadherent patients who were taking up to 3 medications to treat common chronic conditions. The devices may have been more effective if coupled with interventions to ensure consistent use or if targeted to individuals with an even higher risk of nonadherence.

Crane et al. (2017) compared same-day provider medical record documentation and interventions addressing depression and risk behaviors before and after delivering point-of-care patient-reported outcomes (PROs) feedback for patients who self-reported clinically relevant levels of depression or risk behaviors. Conclusions: Implementing same-day PRO collection and feedback into HIV care improves care. Specifically, it improves provider awareness of depression, inadequate adherence, alcohol, and substance use as measured by documentation. PROs decrease how often providers inaccurately documented good adherence. However, PRO impact varies across domains and there is a much greater impact on provider awareness than on actions suggesting the need for additional interventions.

Kronish et al. (2016) aimed to determine the effect of sharing electronically-measured adherence data with clinicians on the management of uncontrolled hypertension in a cluster randomized trial. CONCLUSIONS: Providing clinicians with electronicallymeasured antihypertensive adherence reports reduces inertia in the management of uncontrolled hypertension.

MDs Kronish and Moise comment on medication adherence research in February 2017 JAMA Internal Medicine.

In a multisite randomised clinical trial, Lester et al. (2010) aimed to assess whether mobile phone communication between health-care workers and patients starting antiretroviral therapy in Kenya improved drug adherence and suppression of plasma HIV-1 RNA load. Patients who received SMS support had signifi cantly improved ART adherence and rates of viral suppression compared with the control individuals. Mobile phones might be eff ective tools to improve patient outcome in resource-limited settings.

In this narrative review, Stirratt et al. (2017) make recommendations for how clinicians can better engage with, and benefit, from innovations to improve patient medication adherence and associated treatment outcomes.

Thakkar et al. (2016) conducted a meta-analysis of randomized clinical trials to assess the effect of mobile telephone text messaging on medication adherence in chronic disease. Mobile phone text messaging approximately doubles the
odds of medication adherence. This increase translates into adherence rates improving from 50% (assuming this baseline rate in patients with chronic disease) to 67.8%, or an absolute increase of 17.8%. While promising, these results should be interpreted with caution given the short duration of trials and reliance on self-reported medication adherence measures.

Systematic Review and Meta-analysis from Viswanathan et al. (2015) assessing the effect of MTM intervientions among outpatients with chronic illnesses.  Evidence was graded as insufficient for most outcomes because of inconsistency and imprecision that stem in part from underlying heterogeneity in populations and interventions. Medication therapy management interventions may reduce the frequency of some medication-related problems, including nonadherence, and lower some health care use and costs, but the evidence is insufficient with respect to improvement in health outcomes.

Systematic review from Viswanathan et al. (2012) assessing the comparative effectiveness of patient, provider,
systems, and policy interventions that aim to improve medication adherence for chronic health conditions in the United States. Conclusion: Reduced out-of-pocket expenses, case management, and patient education with behavioral support all improved medication adherence for more than 1 condition. Evidence is limited on whether these approaches are broadly applicable