Comparative strategies to improve medication adherence in chronic disease: what works, for whom, and at what cost

Abstract

Background: Medication non-adherence is common in chronic disease and limits the real-world effectiveness of pharmacotherapy. Adherence is best understood as a process (initiation, implementation, discontinuation/persistence), and intervention choice should match the dominant barrier and phase of adherence. (1)

Methods: For this study researchers conducted an umbrella-style synthesis using PubMed as the primary database (verification/search date: 10 February 2026). Authors prioritised PubMed-indexed systematic reviews, meta-analyses, and Cochrane reviews comparing five intervention families—digital reminders (SMS/apps/interactive voice response), pharmacist-led interventions, regimen simplification (dosing frequency), fixed-dose combinations/polypill strategies, and behavioural counselling (motivational interviewing).  

Results: Digital reminders improve adherence implementation with small-to-moderate pooled effects (electronic reminders: Cohen’s d=0.29; SMS meta-analysis OR 2.11 with an estimated 17.8% absolute gain under a 50% baseline assumption), but clinical effects are uncertain in cardiovascular secondary prevention, where adherence measures are inconsistent and pooled LDL/BP effects are small. (4–7) Pharmacist-led interventions show moderate pooled adherence benefits in older adults (effect size 0.57; 0.41 after outliers) with attenuation over time, and medication review models can improve biomarker target attainment; effects on hospitalisation/mortality are inconsistent. (8,9) Regimen simplification shows a graded adherence advantage using electronic monitoring (e.g., −6.7% taking adherence for twice-daily vs once-daily regimens), supporting simplification as a durable first-line strategy. (12) FDC strategies reduce non-compliance (RR 0.74) and improve adherence/persistence in hypertension (mean adherence +14.92%; persistence RR 1.84), while early polypill evidence shows improved risk factors but uncertain event effects and higher discontinuation, with limited cost reporting. (13–15) MI has a small pooled effect (0.12) and appears most relevant for intentional non-adherence. (16) Economic evidence is limited and heterogeneous; overviews suggest simplification and pharmacist care are often cost-effective but context-dependent. (18,19) Indian RCT evidence suggests education plus follow-up delivered via community health workers/pharmacists is promising but of mixed quality. (20)

Conclusion: The most consistent adherence improvements arise from structural strategies (simplification and FDCs), complemented by clinically integrated pharmacist care and targeted behavioural and digital tools. Better standardisation of adherence outcomes and stronger prospective economic evaluation are priorities for scalable implementation.