Consumer-oriented interventions for evidence-based prescribing and medicines use: an overview of systematic reviews

Vía Sax Institute: PulsE e-bulletin evidence

Numerous systematic reviews exist on interventions to improve consumers’ medicines use, but this research is distributed across diseases, populations and settings. Such differences create challenges for decision makers seeking review-level evidence to inform decisions about medicines use. The objective of the review was to synthesise the evidence from systematic reviews on the effects of interventions which target healthcare consumers to promote evidence-based prescribing for, and medicines use by, consumers. Evidence on the effects on health and other outcomes for healthcare consumers, professionals and services was considered. The review included 37 reviews (18 Cochrane, 19 non-Cochrane). Reviews assessed interventions with diverse aims including support for behaviour change, risk minimisation, skills acquisition and information provision. Medicines adherence was the most commonly reported outcome, but others such as clinical (health and wellbeing), service use and knowledge outcomes were also reported. The evidence was sparse for several populations, including children and young people, carers, and people with multi-morbidity. Promising interventions to improve adherence and other key medicines use outcomes (e.g. adverse events, knowledge) included self-monitoring and self-management, simplified dosing and interventions directly involving pharmacists. Other strategies including reminders, education combined with self-management skills training and counselling, showed promise in relation to adherence but their effects were less consistent. For some interventions, such as information or education provided alone, the evidence suggested ineffectiveness; for many others there was insufficient evidence to determine effects on medicines use outcomes. No interventions were found to be effective to improve all medicines use outcomes across all diseases, populations or settings. Despite the large number of included reviews there are many gaps in the assembled evidence on medicines use strategies, such as those focussing on children, young people or carers, or those for people with more than one coexisting health problem. The authors concluded that decision makers faced with implementing interventions to improve consumers’ medicines use can use this overview to inform these decisions and also to consider the range of interventions available; while researchers and funders can use this overview to determine where research is needed. However, the limitations of the literature relating to the lack of evidence for important outcomes and specific populations, should also be considered.

Ryan R, Santesso N, Hill S, Lowe D, Kaufman C, Grimshaw J. Consumer-oriented interventions for evidence-based prescribing and medicines use: an overview of systematic reviews. Cochrane Database of Systematic Reviews 2011, Issue 5.

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