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The latest evidence for practice

Una Adderley
Specialist Nurse
Team Leader

Does intensified patient care improve adherence to lipid-lowering medication?

Although good evidence exists to show that lipid-lowering medication (LLM) is effective in reducing cardiovascular mortality and morbidity, it is unclear as to the most effective way of encouraging patients to adhere to prescribed LLM regimens. This systematic review sought randomised controlled trials (RCTs) in any language that compared interventions to increase adherence to LLMs with no intervention or usual care for adult ambulatory patients.
Nine RCTs met the selection criteria. The interventions assessed included simplified drug regimens, provision of patient information and education, intensified patient care (eg, telephone reminders and written information) and a complex behavioural approach that involved small group training with postal written information.
The review found evidence to suggest that intensified patient care may improve adherence to lipid-lowering medication for primary or secondary prevention of cardiovascular disease in ambulatory settings. The complex behavioural approach did not differ from usual care in terms of adherence to LLMs.
A commentary suggests that this review makes an important contribution with regard to interventions aimed at encouraging medication adherence. The "intensified patient care" was sometimes multidisciplinary, which raises the question as to which combinations of healthcare professionals should be involved in such interventions.  However, the commentary also notes that since this review did not include any economic information, caution should be used in rolling out any programmes that involve significant financial costs.

Schedlbauer A, Schroeder K, Fahey T. How can adherence to lipid-lowering medication be improved? A systematic review of randomised controlled trials. Fam Pract 2007;4:380-7.

Caldwell PH. Evid Based Nurs 2008;11:51.

Does T'ai Chi reduce the risk of falls in older people?

Falls in older adults are associated with increased mortality and morbidity in older people. T'ai Chi may be effective in reducing the risk of falls in this population group.
This Australian randomised controlled trial recruited 702 people over 60 years of age. All the participants lived in the community and none had practised T'ai Chi in the previous year. People with dementia, degenerative neurological conditions, severely debilitating stroke, severe arthritis, marked vision impairment or inability to walk across a room unaided were excluded from the study. Half the group was randomised to do a 16-week T'ai Chi course, which consisted of a weekly one-hour class with between eight and 15 participants taught by an experienced and accredited T'ai Chi trainer. The remainder were put on a 24-week waiting list.
At 16 weeks, although there was no difference between the groups in terms of rate of falls or the proportion of participants who had had one or more falls, fewer adults in the T'ai Chi group had had two or more falls. At 24 weeks, the T'ai Chi group had had fewer falls. The authors concluded that a 16-week T'ai Chi programme was effective in reducing falls in older adults.
A commentary notes that the reduction in falls continued for up to two months following the end of the T'ai Chi programme. The participants in the T'ai Chi group had to pay for classes but this did not appear to have resulted in a selection bias.
T'ai Chi appears to be another useful option in falls prevention strategies alongside other options such as decreasing clutter in the home, having annual vision and hearing screening, and reviewing medications for possible side-effects.

Voukelatos A, Cumming RG, Lord SR, et al.
A randomized controlled trial of T'ai Chi for the prevention of falls: the Central Sydney T'ai Chi trial. J Am Geriatr Soc 2007;55:1185-91.

Mariano C. Evid Based Nurs 2008:11;60