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4. Results of Intervention Studies

Eighteen of the papers evaluated 16 separate interventions involving two-way communication between patients and health care professionals about medicines. The systematic review includes those studies which involved two-way communication about medicines as part of an intervention and those which assessed the impact of interventions on two-way communication about medicines.
Fifteen of the intervention studies were quantitative and one used a combination of quantitative and qualitative methods. All of the studies were conducted in North America or Europe. Five of the studies involved communication between doctors and patients, six focussed on patients' communication with pharmacists and the remaining five interventions involved nurses or medical assistants.
The intervention studies fulfilled an average of 6 of the 8 methodological quality criteria, with the most common shortcomings being not using random allocation and not providing pre-intervention data. However, the studies had other methodological limitations not explicitly assessed by the criteria, such as not having a comparison group, having the same health professionals involved in the care of patients in more than one group, and small sample sizes. 
Four studies indicated that interventions comprising of training seminars for doctors resulted in the doctors being more likely to reiterate patients' complaints, ask their patients to repeat their medication instructions, address their patients' fears about their new medication, and make it easier for patients to understand medicine instructions. In addition, the patients who the doctors consulted after the seminars gained a better understanding of their medicine. A communication skills programme for psychiatric inpatients also led to improvements in patients' medication knowledge and in their communication with psychiatrists. Patients who completed this programme were judged to be more likely to be compliant compared to the control patients. The only intervention which involved two-way communication between patients and doctors about medicines, in which doctors discussed fact sheets with patients, led to significantly greater increases in patients' medication knowledge than when patients were simply given the fact sheets.
One study found that an advertising campaign designed to encourage patients to ask pharmacists questions about their medicines led to improvements in pharmacists' communication but did not affect patients' question asking. However, another intervention comprising of a written message asking patients to write down their questions did lead to them asking more questions, although it did not affect compliance. Interestingly, both interventions had no significant impact on the amount of information provided to patients. Four other interventions comprising of new or modified pharmacy services which involved two-way communication about medicines resulted in improvements in patients' health outcomes, adherence, satisfaction with services and medication knowledge and decreases in the number of medicines patients were prescribed, their medication problems and the cost of their medication.
A telephone service involving two-way communication about medicines which was provided by a medical assistant to patients at a lipid clinic had no significant impact on adherence, although it did appear to encourage patients to contact a professional to report adverse effects of their medication. A second telephone service provided by a nurse to chemotherapy patients was rated by patients as being helpful. Another intervention involving face-to-face communication with nurses were found to result in greater adherence.

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