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Intervention

Consumer Intervention: Support

Definition

Strategies to provide assistance and encouragement to help consumers cope with and manage their health and related medicines use. Interventions can target patients or carers, as individuals or in groups, and may be delivered face to face or remotely.

Effectiveness

There is sufficient evidence that continuous labour support reduces negative rating of birth experiences, use of analgesia or anaesthesia and labour length. Such support also increases spontaneous vaginal birth without increasing postpartum reports of severe labour pain - it is generally effective. There is some evidence that continuous labour support reduces the number of infants with low 5 minute Apgar score - it is generally effective. However, there is insufficient evidence that continuous labour support reduces synthetic oxytocin use during labour, maternal perineal trauma, neonatal special care nursery admissions or prolonged neonatal hospital stays. Results across the remainder of reviews including support component are mixed. There is some evidence that interventions that provide support alone or in conjunction with other strategies may be effective but results are almost always mixed and interventions do not consistently improve medicines use, adherence or other outcomes. There is insufficient evidence to determine for which diseases support may be effective, or which providers or strategies are the most effective. For example, there is insufficient evidence to determine the effectiveness of smoking cessation interventions designed for Indigenous people, of cancer clinic orientation programs improving patient outcomes, or of behaviour support interventions for improving adherence and other outcomes for children with HIV.

Summary of Overall Findings from Reviews

Summary of Findings Related to Prescribing

28 reviews (16 of high quality) addressed strategies which provided support to consumers to assist them to take medicines safely and effectively.

A review that focused on continuous support during labour support significantly reduced any analgesia (including regional analgesia) or anaesthesia use as well as the negative rating of birth experiences, labour length and the numbers of instrumental vaginal and caesarean births. Such support also increased spontaneous vaginal birth without increasing postpartum reports of severe labour pain; however, use of synthetic oxytocin during labour and perineal trauma were not significantly changed. Continuous labour support compared to usual care also reduced the number of infants with low 5 minute Apgar scores and did not significantly change prolonged neonatal hospital stays and special care nursery admissions (Hodnett 2011). There were no other reviews that focused solely on providing support, but several reviews addressed support strategies as one of several interventions assessed.

Broadly, one large review of adherence-promoting interventions across diseases reported that the majority of effective interventions for long term treatments were complex and included interventions such as counselling, reinforcement, family therapy, psychological therapy and crisis interventions (Haynes 2008). Three reviews with a strong support focus addressed disease-specific counselling to improve medicines use: McIntosh (2006) had too few studies to determine the effects of compliance therapy on medicines use in schizophrenia; while Pekkala (2002) reported improved relapse rates and medicines knowledge, but improved adherence in only a minority of studies of counselling for schizophrenia; and Winterbottom (2008) failed to find any studies on preconception medicines counselling for women with epilepsy.

Other reviews included a support component as part of interventions to improve medicines use such as specialist nurses or specialist epilepsy unit interventions (Bradley 2008) as well as self-management strategies and the delivery of care for children with epilepsy and their families (Lindsay 2011), which had mixed effects on adherence, knowledge and clinical outcomes. Compulsory community treatment orders for patients with severe mental illness did not have significant effects on medicines adherence and perceived coercion, however may improve ratings of victimisation (Kisley 2011). Combining counselling support with nicotine replacement therapy (NRT), when compared to NRT alone, did not alter smoking cessation outcomes (Carson 2012).

There was too little evidence to decide on the effects of support delivered through different professional or care models, including primary care-based asthma clinics in terms of effects on adherence or other outcomes (Jones 2002). Contracts provided with support (counselling reinforcement) did not consistently improve adherence or continuation of treatment (Bosch-Capblanch 2007). Limited evidence exists for support (and medication diary) interventions for children with HIV, with no effect on adherence or patient outcomes when compared to usual care; a peer support group had mixed effects (Bain-Brickley 2011). Mixed effects were also observed for cancer clinic orientation interventions (Chan 2011).

For several other reviews in which support was provided in conjunction with other strategies for specific conditions, there was little effect on medicines use, adherence or other outcomes. In Schroeder (2004) (hypertension) and Rueda (2006) (antiretroviral therapy) adherence increased in about half of studies, while in another (Halpern 2011) only a minority of studies improved contraception continuation.

Reviews listed as "Summary Pending" will be analyzed, summarized and reported at a later date.

The findings will then be incorporated in the overall evidence summaries of the interventions they address.

Reviews Addressing This Intervention Quality Assessment Tool:
AMSTAR Score (of 11 points)
Welsh EJ, Hasan M, Li P. Home-based educational interventions for children with asthma. Cochrane Database of Systematic Reviews 2011 10:CD008469. 11 (High)
Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews 2008 2:CD000011. 10 (High)
Kisely SR, Campbell LA, Preston NJ. Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane Database of Systematic Reviews 2011 2:CD004408. 10 (High)
McIntosh AM, Conlon L, Lawrie SM, Stanfield AC. Compliance therapy for schizophrenia. Cochrane Database of Systematic Reviews 2006 3:CD00344. 10 (High)
Schroeder K, Fahey T, Ebrahim S. Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings. Cochrane Database of Systematic Reviews 2004 2:CD004804. 10 (High)
Bain-Brickley D, Butler LM, Kennedy GE, Rutherford GW. Interventions to improve adherence to antiretroviral therapy in children with HIV infection. Cochrane Database of Systematic Reviews 2011 12:CD009513. 9 (High)
Bosch-Capblanch X, Abba K, Prictor M, Garner P. Contracts between patients and healthcare practitioners for improving patients' adherence to treatment, prevention and health promotion activities. Cochrane Database of Systematic Reviews 2007 2:CD004808. 9 (High)
Bradley PM, Lindsay B. Care delivery and self-management strategies for adults with epilepsy. Cochrane Database of Systematic Reviews 2008 1:CD006244. 9 (High)
Chan RJ, Webster J, Marquart L. Information interventions for orienting patients and their carers to cancer care facilities. Cochrane Database of Systematic Reviews 2011 12:CD008273. 9 (High)
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C, Weston J. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2011 2:CD003766. 9 (High)
Lindsay B, Bradley PM. Care delivery and self-management strategies for children with epilepsy. Cochrane Database of Systematic Reviews 2010 12:CD006245. 9 (High)
Rueda S, Park-Wyllie LY, Bayoumi AM, Tynan AM, Antoniou TA, Rourke SB, Glazier RH. Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS. Cochrane Database of Systematic Reviews 2006 3:CD001442. 9 (High)
Carson KV, Brinn MP, Peters M, Veale A, Esterman AJ, Smith BJ. Interventions for smoking cessation in Indigenous populations. Cochrane Database of Systematic Reviews 2012 1:CD009046. 8 (High)
Halpern V, Lopez LM, Grimes DA, Gallo MF. Strategies to improve adherence and acceptability of hormonal methods of contraception. Cochrane Database of Systematic Reviews 2011 4:CD004317. 8 (High)
Jones A, Fay JK, Ram FSF. Primary care based clinics for asthma. Cochrane Database of Systematic Reviews 2002 1:CD003533. 8 (High)
Pekkala E, Merinder L. Psychoeducation for schizophrenia. Cochrane Database of Systematic Reviews 2002 2:CD002831. 8 (High)
Gleeson T, Iversen MD, Avorn J, Brookhart AM, Katz JN, Losina E, May F, Patrick AR, Shrank WH, Solomon DH. Interventions to improve adherence and persistence with osteoporosis medications: a systematic literature review. Osteoporosis International 2009 20:2127-2134. 6 (Medium)
Holland R, Desborough J, Goodyer L, Hall S, Wright D, Loke YK. Does pharmacist-led medication review help to reduce hospital admissions and deaths in older people? A systematic review and meta-analysis. British Journal of Clinical Pharmacology 2008 65 (3):303-16. 6 (Medium)
Winterbottom JB, Smyth RM, Jacoby A, Baker GA. Preconception counselling for women with epilepsy to reduce adverse pregnancy outcome. Cochrane Database of Systematic Reviews 2008 3:CD006645. 6 (Medium)
Lummis H, Sketris I, Veldhuyzen van ZS. Systematic review of the use of patients' own medications in acute care institutions. Journal of Clinical Pharmacy and Therapeutics 2006 31 (6):541-63. 5 (Medium)
Stevenson FA, Cox K, Britten N, Dundar Y. A systematic review of the research on communication between patients and health care professionals about medicines: the consequences for concordance. Health Expectations 2004 7 (3):235-45. 5 (Medium)
Van Wijk BL, Klungel OH, Heerdink ER, de Boer A. Effectiveness of interventions by community pharmacists to improve patient adherence to chronic medication: a systematic review. Annals of Pharmacotherapy 2005 39 (2):319-28. 5 (Medium)
Vergouwen AC, Bakker A, Katon WJ, Verheij TJ, Koerselman F. Improving adherence to antidepressants: a systematic review of interventions. The Journal of clinical psychiatry 2003 64 (12):1415-20. 5 (Medium)
Wright J, Emerson A, Stephens M, Lennan E. Hospital inpatient self-administration of medicine programmes: a critical literature review. Pharmacy World & Science 2006 28 (3):140-51. 5 (Medium)
Amico KR, Harman JJ, Johnson BT. Efficacy of antiretroviral therapy adherence interventions: a research synthesis of trials, 1996 to 2004. Journal of Acquired Immune Deficiency Syndromes 2006 41 (3):285-97. 4 (Medium)
Odegard PS, Capoccia K. Medication taking and diabetes: a systematic review of the literature. The Diabetes Educator 2007 33 (6):1014-29. 4 (Medium)
Russell CL, Conn VS, Jantarakupt P. Older adult medication compliance: integrated review of randomized controlled trials. American Journal of Health Behavior 2006 30 (6):636-50. 4 (Medium)
Zygmunt A, Olfson M, Boyer CA, Mechanic D. Interventions to improve medication adherence in schizophrenia. The American Journal of Psychiatry 2002 159 (10):1653-64. 4 (Medium)
Chersich MF, Luchters S, Ntaganira I, Gerbase A, Lo YR, Scorgie F, Steen R. Priority interventions to reduce HIV transmission in sex work settings in sub-Saharan Africa and delivery of these services. Journal of the International AIDS Society 2013 16 (1):17980. Summary Pending
Clarkesmith DE, Pattison HM, Lane DA. Educational and behavioural interventions for anticoagulant therapy in patients with atrial fibrillation. Cochrane Database of Systematic Reviews 2013 6:CD008600. Summary Pending
Easthall C, Song F, Bhattacharya D. A meta-analysis of cognitive-based behaviour change techniques as interventions to improve medication adherence. Bmj open 2013 3 (8):2749. Summary Pending
Gentry S, van-Velthoven MH, Tudor CL, Car J. Telephone delivered interventions for reducing morbidity and mortality in people with HIV infection. Cochrane Database of Systematic Reviews 2013 5:CD009189. Summary Pending
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2012 10:CD003766. Summary Pending
Stead LF, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database of Systematic Reviews 2012 10:CD008286. Summary Pending
Thompson L, McCabe R. The effect of clinician-patient alliance and communication on treatment adherence in mental health care: a systematic review. BMC Psychiatry 2012 12:87. Summary Pending
van-Velthoven MH, Tudor CL, Gentry S, Car J. Telephone delivered interventions for preventing HIV infection in HIV-negative persons. Cochrane Database of Systematic Reviews 2013 5:CD009190. Summary Pending
Waterman H, Evans JR, Gray TA, Henson D, Harper R. Interventions for improving adherence to ocular hypotensive therapy. Cochrane Database of Systematic Reviews 2013 4:CD006132. Summary Pending