Summary of findings for intervention components seeking to improve adherence (outcome adherence reported as dichotomous)
| Components (versus standard care) | Anticipated absolute effects (95% CI) | Relative effect (95% CI) | Participants (studies), n | SUCRA (p-value) | Certainty of the evidence (GRADE) | Comments | |
|---|---|---|---|---|---|---|---|
| Risk with standard care | Risk with components# | ||||||
| Education | 428 per 1000 | 781 per 1000 (628–884) | OR 4.77 (2.25–10.14) | 528 (5 RCTs) | 0.9999 | ⊕⊕○○ Low¶,+,§ | Education, as a stand-alone component, may result in a large increase in adherence compared to standard care, based on an MCID of 50 per 100 |
| Education+motivation | 428 per 1000 | 475 per 1000 (433–517) | OR 1.21 (1.02–1.43) | 538 (5 RCTs) | 0.6339 | ⊕○○○ Very low¶,+,ƒ | The association of education and motivation may not improve adherence compared to standard care but the evidence is very uncertain, based on an MCID of 50 per 100 |
| Telemedicine | 428 per 1000 | 426 per 1000 (369–483) | OR 0.99 (0.78–1.25) | 432 (5 RCTs) | 0.1850 | ⊕○○○ Very low¶,+ | Telemedicine, as a stand-alone component, may not improve adherence compared to standard care but the evidence is very uncertain, based on an MCID of 50 per 100 |
| Standard care | 383 (5 RCTs) | 0.1812 | |||||
Patient or population: COPD; settings: clinical (inpatient and outpatient) and community pharmacies; intervention components: education, motivation, telemedicine; comparison: standard care; follow-up: range 6–12 months. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group grades of evidence are as follows. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. SUCRA: surface under the cumulative ranking; OR: odds ratio; RCT: randomised controlled trial; MCID: minimal clinically important difference. #: the risk with components (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI), but it is based on the risk of the corresponding component; ¶: downgraded by two levels for risk of bias because all the evidence is from studies at high risk of bias and some concern, and no study is at low risk of bias; +: downgraded by one level for inconsistency because the CIs do not overlap, but the effect estimates are on the same side of the line of no effect; §: upgraded by one level because of the large OR; ƒ: downgraded by two levels for imprecision because the 95% CI crosses the threshold.