Barriers and Strategies for Improving Medication Adherence Among People Living With COPD: A Systematic Review

BACKGROUND: While medication is an integral component of the effective management of COPD, contemporary studies report that more than half of all people who are prescribed medication for the management of their COPD do not adhere to therapy. Enhancing medication adherence and improving health outcomes for those living with COPD are among the key challenges for the global health community. This systematic review aims to identify the rate of nonadherence among people who are prescribed controller medication for the management of their COPD, and identifies the barriers and facilitators that influence their medication use behavior. METHODS: A systematic search of medical databases (ie, MEDLINE, CINHAL, and EMBASE) was conducted using key words to identify literature in the English language, published between January 2003 and December 2019. Included studies were assessed for quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. RESULTS: A total of 1,474 studies were identified from the initial database search, of which 38 met the inclusion criteria. Of these 38 studies, 37 reported on rates of nonadherence (ranging from 22% to 93%), 30 reported on barriers to adherence, 24 reported on enablers to adherence, and 16 reported on both. The majority (33) of the studies were conducted in high-income nations. The quality of articles ranged from 47% to 90%. Medication-taking behavior was reported to be influenced by several factors such as subjects' beliefs about medication, their experiences of and satisfaction with medication effectiveness, their concerns regarding medication side effects, their personal circumstances, habits and health status, and their relationships with health care providers. CONCLUSIONS: Adherence to COPD medication was generally low, with the majority of studies identifying the presence of depression and subjects' concern about the harmful effects of the medicine as barriers to adherence. Variability exists on the reported rates of nonadherence, possibly due to different measures utilized to assess adherence. Future research in low-income nations is needed.