META-ANALYSIS OF NURSE-LED INTERVENTIONS ON MEDICATION ADHERENCE AND CLINICAL OUTCOMES IN PATIENTS WITH CHRONIC ILLNESSES
DOI:
https://doi.org/10.71000/w46qy993Keywords:
Chronic Disease, Clinical Outcomes, Medication Adherence, Meta-Analysis, Nurse-Led Interventions, Nursing Care, Patient Compliance.Abstract
Background: Chronic illnesses such as diabetes, hypertension, and cardiovascular disease require consistent medication adherence to achieve optimal clinical outcomes. Despite its importance, non-adherence remains a global challenge, leading to increased morbidity, mortality, and healthcare costs. Nurse-led interventions have emerged as a promising approach to enhance adherence through education, counseling, and continuous follow-up.
Objective: To synthesize existing evidence on the effectiveness of nurse-led interventions in improving medication adherence and clinical outcomes among patients with chronic illnesses.
Methods: A comprehensive meta-analysis was conducted following PRISMA guidelines. Databases including PubMed, Scopus, CINAHL, Cochrane CENTRAL, and Embase were searched for studies published up to June 2025. Eligible studies included randomized controlled trials and quasi-experimental designs assessing nurse-led interventions on adherence or clinical outcomes in chronically ill adults. Data were extracted and analyzed using Comprehensive Meta-Analysis software (version 3.0). Random-effects models calculated pooled standardized mean differences (SMD) with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic, and publication bias was examined through Egger’s regression test.
Results: Twenty-two studies involving 7,250 participants were included. Nurse-led interventions significantly improved medication adherence across multiple tools (pooled SMD = 0.93, 95% CI: 0.71–1.14; p < 0.001). Clinical outcomes also improved: HbA1c decreased by 1.1% in diabetic patients, systolic blood pressure reduced by 8.3 mmHg in hypertensive patients, and readmission rates in heart failure reduced by 32%. Hybrid and face-to-face intervention models demonstrated the strongest effects, while telehealth interventions showed moderate benefits.
Conclusion: Nurse-led interventions substantially enhance medication adherence and key clinical outcomes among patients with chronic diseases. Integrating structured nurse-led programs into chronic care models can foster long-term adherence, reduce complications, and optimize health system performance.
References
Salem BE, Klansek E, Morisky DE, Shin SS, Yadav K, Chang AH, et al. Acceptability and Feasibility of a Nurse-Led, Community Health Worker Partnered Latent Tuberculosis Medication Adherence Model for Homeless Adults. Int J Environ Res Public Health. 2020;17(22).
Uhlig T, Karoliussen LF, Sexton J, Kvien TK, Haavardsholm EA, Taylor WJ, et al. Beliefs about medicines in gout patients: results from the NOR-Gout 2-year study. Scand J Rheumatol. 2023;52(6):664-72.
Du Plessis J, Temane A, Poggenpoel M. A conceptual framework for psychiatric nurses to facilitate medication compliance among adults living with depression. Curationis. 2024;47(1):e1-e13.
Towfighi A, Cheng EM, Ayala-Rivera M, Barry F, McCreath H, Ganz DA, et al. Effect of a Coordinated Community and Chronic Care Model Team Intervention vs Usual Care on Systolic Blood Pressure in Patients With Stroke or Transient Ischemic Attack: The SUCCEED Randomized Clinical Trial. JAMA Netw Open. 2021;4(2):e2036227.
Nyamathi A, Salem BE, Shin SS, Jones AA, Garfin DR, Yadav K, et al. Effect of a Nurse-Led Community Health Worker Intervention on Latent Tuberculosis Medication Completion Among Homeless Adults. Nurs Res. 2021;70(6):433-42.
Yang C, Lee DTF, Wang X, Chair SY. Effects of a nurse-led medication self-management intervention on medication adherence and health outcomes in older people with multimorbidity: A randomised controlled trial. Int J Nurs Stud. 2022;134:104314.
Liu Q, Wang J, Han J, You T, Li L. Effects of Seamless Operating Room Nursing Combined with Multistyle Health Education on the Psychological State, Rehabilitation Quality, and Nursing Satisfaction in Patients with Internal Fixation of Femoral Fracture. J Healthc Eng. 2022;2022:5196363.
Logan DR, Zipp GP. Home Care Nurses' Knowledge and Attitudes Regarding Telehealth to Promote Medication Compliance among Older Adults. Home Healthc Now. 2024;42(1):31-5.
Probst S, Saini C, Bobbink P, Frei A, Dudley-Martin F, Gafner S, et al. The Impact of a Multidisciplinary Patient Education Program on Venous Leg Ulcer Healing: A Randomised Controlled Trial. Wound Repair Regen. 2025;33(5):e70084.
Balikai SI, Rentala S, Mudakavi IB, Nayak RB. Impact of nurse-led medication adherence therapy on bipolar affective disorder: A randomized controlled trial. Perspect Psychiatr Care. 2022;58(4):2676-86.
Hu W, Li T, Cao S, Gu Y, Chen L. Influence of Nurse-Led Health Education on Self-Management Ability, Satisfaction, and Compliance of Elderly Patients with Chronic Obstructive Pulmonary Disease Based on Knowledge, Belief, and Practice Model. Comput Math Methods Med. 2022;2022:1782955.
Stokes H, Jones J, Worth C, Nicholson J, Fullwood C, Banerjee I. Integration of nurse-led virtual reviews with growth hormone device-linked patient adherence information: a mixed methods feasibility study. Front Endocrinol (Lausanne). 2023;14:1167854.
Cuesta-Zigorraga A, Arrue M, Labaka A. A Nurse-Led Education Program to Improve COVID-19 Prevention Knowledge Among Adolescent Students. J Sch Health. 2023;93(12):1091-8.
Jiang L, Yan J, Yao J, Jing X, Chen Y, Deng Y, et al. Nurse-led follow-up care versus routine health education and follow-up in diabetes patients: An effectiveness analysis. Medicine (Baltimore). 2024;103(22):e38094.
Han Y, Chen J, Xu Y, Huang P, Hou L. Nurse-led medication management as a critical component of transitional care for preventing drug-related problems. Aging Clin Exp Res. 2024;36(1):151.
van Zanten R, van Dijk M, van Rosmalen J, Beck DK, van Staa A, Van Hecke A, et al. Nurse-Led Self-Management Support After Organ Transplantation - A Multicenter, Stepped-Wedge Randomized Controlled Trial. Transpl Int. 2024;37:13175.
Thomas D, Summers RH. Patients' perceptions and experiences of directly observed therapy for TB. Br J Nurs. 2022;31(13):680-9.
Ramamurthy A, Bhanbhro S, Bruce F, Collier-Sewell F. Racialised experiences of Black and Brown nurses and midwives in UK health education: A qualitative study. Nurse Educ Today. 2023;126:105840.
Lee MK, Walsh E, Willgerodt M, O'Connor MR. School Nurses' Diabetes-Related Attitudes and Self-efficacy in Diabetes Education and Management. J Sch Nurs. 2023;39(6):487-95.
Muench U, Whaley C, Coffman J, Spetz J. Scope-of-Practice for Nurse Practitioners and Adherence to Medications for Chronic Illness in Primary Care. J Gen Intern Med. 2021;36(2):478-86.
Hasnaoui, A., Casabona, E., Martin, B., Campagna, S., & Dimonte, V. (2024). Nurse-Led Interventions for Improving Medication Adherence in Chronic Diseases: A Systematic Review. Healthcare, 12(23), 2337.
Kim, C.-J., Kim, M., Lee, G.-Y., & Park, E. (2022). Effectiveness of nurse-led interventions on medication adherence in adults taking medication for metabolic syndrome: A systematic review and meta-analysis. Journal of Clinical Nursing.
Choog, K.-J., & Park, E. (2022). Effects of medication adherence interventions for older adults with chronic illnesses: A systematic review and meta‐analysis. Osong Public Health and Research Perspectives, 13(5), 328–340.
Nursing-led medication management as a critical component of transitional care: The role of nurses in correcting drug-related problems and improving outcomes. (2024). BMJ Transitional Care.
The short and long-term efficacy of nurse-led interventions for medication adherence: A multi-study review. (2024). BMC Primary Care, 25(1).
Interventions to promote medication adherence for chronic diseases: A systematic review in India. (2023). Frontiers in Public Health, 11, 1194919.
Albiladi B, Aljabri K, Alrowatai B, Alsuhimi M, Alamri A, Alharbi R, Alharbi S, Aljabri B. Nurse-led Interventions to Enhance Adherence to Chronic Medications. International Journal for Scientific Research. 2023;2(11):312-25.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Abdul Rehman, Zarina Naz, Aiza Ali, Fouzia Naz, Farhana Tabassum Siddique (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
