Phase-specific strategies and interventions to enhance medication adherence across different phases in ADHD: a systematic review and meta-analysis

ABSTRACT

Introduction

This systematic review and meta-analysis assessed the characteristics, types, and impact of interventions to improve adherence to attention-deficit hyperactivity disorder (ADHD) medications within the context of the three phases of adherence, namely, initiation, implementation, and discontinuation.

Methods

PubMed, Psychological Information Database, Embase, International Pharmaceutical Abstracts, and Google Scholar were systematically searched for relevant trials using appropriate search terms. Interventions were classified as educational, behavioural, affective, and multifaceted. Data was pooled using odds ratios and proportions.

Results

Seventeen studies were included in this review. In a pooled analysis of four RCTs, interventions did not significantly improve medication adherence (OR = 2.32; 95%-Confidence Interval=CI = 0.91–5.90; p = 0.08). In seven non-randomized trials, a pooled proportion of people who adhered to ADHD medication was considerably higher in the intervention group (85%, 95%CI = 78%-91%) than in the control group (47%, 95%CI = 33%–61%). Interventions varied in terms of study design, methods and their impact on different phases of adherence.

Conclusions

Despite some promising results, the lack of consideration of phase-specific adherence factors may limit the effectiveness and sustainability of interventions to improve adherence in clinical practice. Future interventions should be phase-specific, guided by factors which are pertinent to each phase. Meanwhile, clinicians should choose or tailor interventions based on individual needs and preferences.

KEYWORDS:

• Medication adherence
• intervention
• ADHD
• systematic review
• meta-analysis
• adherence phases
• phase-specific factors

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Availability of data

Data supporting the findings of this study are available within the article and its supplementary materials.

Author contributions

MU Khan conceived the research idea. MU Khan and SS Hasan designed the study and were involved in screening articles, data extraction, analysis, and interpretation. MU Khan wrote the first draft. MU Khan and SS Hasan revised and approved the manuscript for final submission. All authors agree to be accountable for all aspects of the work.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737175.2024.2360118

Additional information

Funding

This paper was not funded.