Closing the quality gap: revisiting the state of the science (vol. 4: medication adherence interventions: comparative effectiveness).
Closing the quality gap: revisiting the state of the science (vol. 4: medication adherence interventions: comparative effectiveness).
复制标题
缩小质量差距：重新审视科学现状（第 4 卷：药物依从性干预措施：比较有效性）。
DOI：
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
K. Lohr
中科院分区：
文献类型：
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作者：
M. Viswanathan;C. Golin;Christine D Jones;M. Ashok;S. Blalock;R. Wines;Emmanuel Coker;Catherine A. Grodensky;D. Rosen;A. Yuen;Priyanka Sista;K. Lohr
目标
评估患者、提供者和系统干预（关键问题[KQ] 1）或政策干预（KQ 2）在改善一系列慢性健康状况的药物依从性方面的有效性。对于有效提高依从性的干预措施，我们随后评估了其在改善健康、医疗保健利用和不良事件方面的有效性。
数据源
MEDLINE®，科克伦图书馆。从参考文献清单和技术专家那里找到了其他研究。
复习方法
两人独立选择、提取相关试验和系统评价的数据，并对偏倚风险进行评级。我们分别对每种临床状况和每种状况下的干预类型的有效性证据进行了综合。我们还评估了各种临床条件下干预成分的流行率以及干预措施对一系列弱势人群的有效性。两名评审员使用既定标准对证据的强度进行分级。
结果
我们在对3,979篇摘要的回顾中发现了62项合格的研究（58项试验和4项观察性研究）。这些研究包括糖尿病、高脂血症、高血压、心力衰竭、心肌梗死、哮喘、抑郁症、青光眼、多发性硬化症、肌肉骨骼疾病和多种慢性疾病患者。57项患者、提供者或系统干预试验（KQ 1）评估了20种不同类型的干预措施; 4项观察性研究和1项政策干预试验（KQ 2）评估了减少自付费用或提高处方药覆盖率的效果。我们发现了改善药物依从性的最一致的证据，以减少自付费用或改善处方药覆盖率，病例管理和教育干预措施。在临床条件下，我们发现最强有力的支持自我管理的药物，短期改善哮喘患者的依从性;合作护理或病例管理计划，短期改善依从性，改善服用抑郁症药物的患者的症状;以及药剂师领导的高血压患者改善收缩压的方法。
结论
不同的干预措施为改善慢性病的药物依从性提供了有希望的方法，特别是在短期内。关于这些方法是否对临床条件和人群具有广泛适用性的证据是有限的，关于长期药物依从性或健康结果的证据也是如此。
OBJECTIVES
To assess the effectiveness of patient, provider, and systems interventions (Key Question [KQ] 1) or policy interventions (KQ 2) in improving medication adherence for an array of chronic health conditions. For interventions that are effective in improving adherence, we then assessed their effectiveness in improving health, health care utilization, and adverse events.
DATA SOURCES
MEDLINE®, the Cochrane Library. Additional studies were identified from reference lists and technical experts.
REVIEW METHODS
Two people independently selected, extracted data from, and rated the risk of bias of relevant trials and systematic reviews. We synthesized the evidence for effectiveness separately for each clinical condition, and within each condition, by type of intervention. We also evaluated the prevalence of intervention components across clinical conditions and the effectiveness of interventions for a range of vulnerable populations. Two reviewers graded the strength of evidence using established criteria.
RESULTS
We found a total of 62 eligible studies (58 trials and 4 observational studies) from our review of 3,979 abstracts. These studies included patients with diabetes, hyperlipidemia, hypertension, heart failure, myocardial infarction, asthma, depression, glaucoma, multiple sclerosis, musculoskeletal diseases, and multiple chronic conditions. Fifty-seven trials of patient, provider, or systems interventions (KQ 1) evaluated 20 different types of interventions; 4 observational studies and one trial of policy interventions (KQ 2) evaluated the effect of reduced out-of-pocket expenses or improved prescription drug coverage. We found the most consistent evidence of improvement in medication adherence for interventions to reduce out-of-pocket expenses or improve prescription drug coverage, case management, and educational interventions across clinical conditions. Within clinical conditions, we found the strongest support for self-management of medications for short-term improvement in adherence for asthma patients; collaborative care or case management programs for short-term improvement of adherence and to improve symptoms for patients taking depression medications; and pharmacist-led approaches for hypertensive patients to improve systolic blood pressure.
CONCLUSIONS
Diverse interventions offer promising approaches to improving medication adherence for chronic conditions, particularly for the short term. Evidence on whether these approaches have broad applicability for clinical conditions and populations is limited, as is evidence regarding long-term medication adherence or health outcomes.