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Medication Non-Adherence Identified at Home: A Systematic Review and Meta-analysis

Background: Patients dwelling at home are at risk of medication non-adherence which is directly associated with poor treatment outcomes. This study aimed to estimate the prevalence rate of medication non-adherence occurring at patient’s home.

Methods: EMBASE, PUBMED/MEDLINE, SCOPUS and CINAHL were searched from their inceptions to January 2016. Original articles were included if they enrolled patients home domiciled and provided sufficient data for calculating the prevalence. The quality assessment of included studies was performed using Crombie’s items. Pooled estimates were obtained by using random-effect model. STATA was used for data analysis.

Results: Of 3398 articles identified, 13 met the inclusion criteria. The median prevalence of medication non-adherence detected in home settings was 38.6% [Interquartile range (IQR): 12.8-53%]. According to population, the median prevalence in elderly was 43.2% (IQR: 13.2-57.7%) whereas that in allaged population was 8.4% (95% CI, 6.3-10.5%; χ2 0.61; d.f.1; I2=0%; p=0.435). Using pill count as a method of detection showed the highest medication non-adherence rate (70%, 95% CI; 61-79%). High income countries reported a higher levels of non-adherence to medications (median 46.8%, IQR: 26.4- 57.7%) than lower middle-income countries (9.6%, 95% CI; 5.7-13.5%) or upper middle-income countries (8.4%, 95% CI; 6.3-10.5%; χ2 0.61; d.f.1; I2=0%; p=0.435). Medication involving cardiovascular, alimentary tract and metabolic and respiratory diseases were most implicated with non-adherence.

Conclusion: Non-adherence to medication detected at patients’ home was appreciable. Healthcare professional should be aware of adherence problems in community and further design an effective strategy for improving adherence to achieve desired therapeutic outcomes and safety.


Pajaree Mongkhon, Chuenjid Kongkaew

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