Noncompliance with ocular hypotensive treatment in patients with glaucoma or ocular hypertension - An evidence-based review
Noncompliance with ocular hypotensive treatment in patients with glaucoma or ocular hypertension - An evidence-based review
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DOI：
10.1016/j.ophtha.2004.12.035
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发表时间：
2005-06-01
期刊：
影响因子：
13.7
通讯作者：
Webers, CAB
中科院分区：
文献类型：
--
作者：
Olthoff, CMG;Schouten, JSAG;Webers, CAB
目的：总结现有的科学证据，以支持青光眼患者如何处理不依从性的临床决策。临床相关性：青光眼患者由于不遵守局部治疗而导致的眼压下降不足和视野(VF)丧失的进行性变化可能导致不必要的治疗，增加风险和成本。我们在MEDLINE、EMBASE、CINAHL、心理学信息、Cochrane和参考文献列表数据库中进行了文献搜索。纳入了34篇文章，描述了29项原始的定量研究，包括英语、德语、法语或荷兰语。药物试验中的不依从性研究被排除在外。两名研究人员独立选择文章并提取其内容，然后协商纳入或排除。结果：患者偏离处方用药方案的比例从5%到80%不等。不依从性对临床结果的影响尚未确定。没有足够灵敏和具体的决定因素来准确识别潜在的不合规者。患者知识和剂量频率可作为提高依从性的起点。患者教育和防止遗忘剂量的结合似乎成功地提高了患者的依从性。结论：在青光眼患者中，不遵守降压治疗的情况很常见。然而，没有强有力的证据支持不顺应性和室颤丢失的进展之间的关系。从目前可用的文献中，只有几个临床医生指南可以得出。未来的研究应以临床相关问题为指导。
Objective: To summarize the available scientific evidence to support clinical decisions on how to deal with noncompliance in glaucoma patients.Clinical Relevance: Insufficient reduction of intraocular pressure and progression of visual field (VF) loss in glaucoma patients due to noncompliance with topical treatment may result in unnecessary therapy, with additional risks and costs.Methods/Literature Reviewed. We conducted a literature search in the databases MEDLINE, EMBASE, CINAHL, PsychInfo, and Cochrane and reference lists. Thirty-four articles describing 29 original quantitative studies, in English, German, French, or Dutch, were included. Studies on noncompliance in drug trials were excluded. Two investigators independently selected the articles and abstracted their content, before negotiating their inclusion or exclusion.Results: The proportions of patients who deviate from their prescribed medication regimen ranged from 5% to 80%. The impact of noncompliance on clinical outcome has not yet been established. There are no determinants sensitive and specific enough to identify potential noncompliers accurately. Patient knowledge and dose frequency can be used as starting points to improve compliance. A combination of patient education and prevention of forgetting doses seems to be successful in enhancing patient compliance.Conclusion: Noncompliance with hypotensive treatment is common among glaucoma patients. However, there is no strong evidence supporting a relation between noncompliance and progression of VF loss. Only a few guidelines for clinicians can be derived from the currently available literature. Future research should be guided by clinically relevant questions.