Medication adherence trajectory of patients with chronic diseases and its influencing factors: A systematic review

Aims To synthesize the published studies on medication adherence trajectories among patients with chronic diseases and identify the influencing factors.Design Systematic review.Data Sources Medline (Ovid), Embase (Ovid) and Web of Science core collection were searched from database inception to 1 July 2022.Review Methods Potentially eligible articles were independently screened by three reviewers using set inclusion and exclusion criteria. The Joanna Briggs Institute critical appraisal checklist for cohort studies was used to appraise the quality of the included articles. Three reviewers independently evaluated the quality, extracted data and resolved differences by consensus. Results were presented using descriptive synthesis, and the prevalence of recategorised medication adherence trajectories was calculated from the published data.Results Fifty studies were included. Medication adherence trajectories among patients with chronic diseases were synthesized into six categories: adherence, non-adherence, decreasing adherence, increasing adherence, fluctuating adherence and moderate adherence. Low and moderate evidence showed that (1) patient-related factors, including age, sex, race, marital status and mental status; (2) healthcare team and system-related factors, including healthcare utilization, insurance and primary prescriber specialty; (3) socioeconomic factors including education, income and employment status; (4) condition-related factors including complications and comorbidities and (5) therapy-related factors including the number of medications, use of other medications, and prior medication adherence behaviours were factors influencing the medication adherence trajectory. Marital status and prior medication adherence behaviour were the only influencing factors with moderate evidence of an effect.Conclusion The medication adherence trajectory among patients with chronic diseases varied widely. Further studies are warranted to determine contributory factors.Implications for the Profession Healthcare providers should be aware that patients' medication adherence has different trajectories and should take appropriate measures to improve patients' medication adherence patterns.Patient or Public Contribution None. As a systematic review, patients and the public were not involved.