TY - JOUR T1 - Learning from successes: designing medication adherence intervention research so that we can learn what works and why JF - BMJ Quality & Safety JO - BMJ Qual Saf DO - 10.1136/bmjqs-2021-013381 SP - bmjqs-2021-013381 AU - Sara Garfield AU - Gaby Judah Y1 - 2021/07/11 UR - http://qualitysafety.bmj.com/content/early/2021/07/11/bmjqs-2021-013381.abstract N2 - “Drugs don’t work in patients who don’t take them”—C.E. Koop, US Surgeon General1Even if clinicians prescribe the most appropriate medications for their patients, the effectiveness of these depends on how patients take them.1 Adherence presumes an agreement between prescriber and patient about the prescriber’s recommendations2 and is defined as the extent to which the patient’s action matches the agreed recommendations.2 Low adherence is associated with adverse outcomes, hospitalisation and increased mortality.3 It is therefore a source of avoidable patient harm, as well as increased healthcare costs and reduced cost-effectiveness of medicines.4–7 However, approximately 30%–50% of patients with long-term conditions are estimated to be non-adherent to their medication.4 A systematic review has found that while many studies have evaluated the effects of interventions to increase adherence, most appear to have limited effects.8 Of 182 randomised controlled studies, only 17 had a low risk of bias, and only 5 of these demonstrated an increase in both adherence and clinical outcomes.8 In addition, these effects were generally small, and interventions were complex and not necessarily scalable to routine clinical practice. The authors of the review concluded that it was not possible to make generalisations about what types of interventions work and which do not. This lack of clear recommendations for intervention design is a challenge to researchers as well as to clinicians trying to improve medication adherence.The publication in this issue9 of the evaluation of an adherence intervention with a large sample size, that both increased adherence and improved clinical outcomes, is therefore a helpful addition to the literature. In this study, Torres-Robles and colleagues report a cluster randomised controlled trial of an individually tailored intervention to increase medication adherence in patients with hypertension, asthma or chronic obstructive pulmonary disease. The … ER -