Medication adherence outcomes of 771 intervention trials: Systematic review and meta-analysis.
Medication adherence outcomes of 771 intervention trials: Systematic review and meta-analysis.
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DOI：
10.1016/j.ypmed.2017.03.008
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发表时间：
2017-06
影响因子：
5.1
通讯作者：
Ruppar TM
中科院分区：
文献类型：
--
作者：
Conn VS;Ruppar TM
良好的药物依从性有助于降低发病率、死亡率和医疗费用。虽然研究人员已经测试了许多干预措施来提高依从性，但结果有时相互矛盾，而且往往不清楚。本系统性综述应用荟萃分析程序整合了测试药物依从性干预措施的主要研究。2015年完成的综合检索找到了771项已发表和未发表的干预研究，这些研究具有依从性行为结局。随机效应模型分析计算标准化的平均差异效应大小。荟萃分析主持人分析研究了依从性效应量与样本、设计和干预特征之间的关联。2016年进行了分析。计算出比较治疗组和对照组的标准化平均差异效应量为0.290。主持人分析显示，基于习惯和行为目标（与认知为重点）的干预措施的效果更大。最有效的干预措施是由药剂师面对面提供，并直接向患者提供。在老年人和无家可归的参与者的研究中，效应量较小。偏倚的风险是常见的;在使用设盲数据收集器和意向性治疗分析的研究中，效应量显著较低。使用药物电子事件监测和药丸计数药物依从性测量的研究报告了最大的效应量。存在发表偏倚。这项迄今为止最全面的审查表明，虽然干预措施可以提高依从性，但仍有很大的改进余地。研究结果表明，卫生保健提供者应该把干预内容集中在行为策略上，特别是基于习惯的干预，而不是旨在改变知识和信念的认知策略。
Excellent medication adherence contributes to decreases in morbidity, mortality, and health care costs. Although researchers have tested many interventions to increase adherence, results are sometimes conflicting and often unclear. This systematic review applied meta-analytic procedures to integrate primary research that tested medication adherence interventions. Comprehensive searching completed in 2015 located 771 published and unpublished intervention studies with adherence behavior outcomes. Random-effects model analysis calculated standardized mean difference effect sizes. Meta-analytic moderator analyses examined the association between adherence effect sizes and sample, design, and intervention characteristics. Analyses were conducted in 2016. A standardized mean difference effect size of 0.290 comparing treatment and control groups was calculated. Moderator analyses revealed larger effect sizes for habit-based and behavioral-targeted (vs. cognitive-focused) interventions. The most effective interventions were delivered face-to-face, by pharmacists, and administered directly to patients. Effect sizes were smaller in studies with older and homeless participants. Risks of bias were common; effect sizes were significantly lower among studies with masked data collectors and intention-to-treat analyses. The largest effect sizes were reported by studies using medication electronic event monitoring and pill count medication adherence measures. Publication bias was present. This most comprehensive review to date documented that, although interventions can increase adherence, much room remains for improvement. Findings suggest health care providers should focus intervention content on behavioral strategies, especially habit-based interventions, more so than cognitive strategies designed to change knowledge and beliefs.