Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings.
Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings.
复制标题
提高门诊高血压患者治疗依从性的干预措施。
DOI：
10.1002/14651858.cd004804
复制
发表时间：
2004
期刊：
影响因子：
--
通讯作者：
S. Ebrahim
中科院分区：
文献类型：
--
作者：
K. Schroeder;T. Fahey;S. Ebrahim
背景
缺乏对降血压药物的依从性是全世界高血压控制不佳的主要原因。随机试验已经评估了提高抗高血压药物依从性的干预措施，但尚不清楚哪些干预措施有效。
目标
确定旨在提高成人高血压患者降血压药物依从性的干预措施的有效性
搜寻策略
2002 年 4 月对 Cochrane 对照试验注册库 (CCTR)、MEDLINE、EMBASE 和 CINAHL 中的所有文章（任何年份）进行全语言检索。
选择标准
旨在提高初级保健中原发性高血压成人患者对降压药物依从性的干预措施的随机对照试验，以药物依从性和血压控制为结果
数据收集和分析
两位作者独立地重复提取数据，并根据 Cochrane 协作手册概述的标准评估每项研究。
主要结果
我们纳入了 38 项研究，测试了 58 种不同的干预措施，并包含 15519 名患者的数据。这些研究于 1975 年至 2000 年间在 9 个国家进行。随访时间从 2 个月到 60 个月不等。由于研究之间在干预措施和用于衡量依从性的方法方面存在异质性，我们没有汇总结果。九项研究中有七项通过简化给药方案提高了依从性，依从性相对提高了 8% 至 19.6%。 24 项研究中，有 10 项研究的激励策略取得了成功，依从性总体小幅提高，最高可达 23%。 18 项研究中有 8 项涉及多种技术的复杂干预措施提高了依从性，比例从 5% 到最高 41% 不等。仅靠患者教育似乎在很大程度上是不成功的。
审稿人的结论
减少每日剂量似乎可以有效提高降血压药物的依从性，应将其作为一线策略进行尝试，尽管很少有证据表明对降血压有影响。一些激励策略和复杂的干预措施似乎很有希望，但我们需要通过精心设计的随机对照试验来证明其效果的更多证据。
BACKGROUND
Lack of adherence to blood pressure lowering medication is a major reason for poor control of hypertension worldwide. Interventions to improve adherence to antihypertensive medication have been evaluated in randomised trials but it is unclear which interventions are effective.
OBJECTIVES
To determine the effectiveness of interventions aiming to increase adherence to blood pressure lowering medication in adults with high blood pressure
SEARCH STRATEGY
All-language search of all articles (any year) in the Cochrane Controlled Trials Register (CCTR), MEDLINE, EMBASE, and CINAHL in April 2002.
SELECTION CRITERIA
RCTs of interventions to increase adherence to blood pressure lowering medication in adults with essential hypertension in primary care, with adherence to medication and blood pressure control as outcomes
DATA COLLECTION AND ANALYSIS
Two authors extracted data independently and in duplicate and assessed each study according to the criteria outlined by the Cochrane Collaboration Handbook.
MAIN RESULTS
We included 38 studies testing 58 different interventions and containing data on 15519 patients. The studies were conducted in nine countries between 1975 and 2000. The duration of follow-up ranged from two to 60 months. Due to heterogeneity between studies in terms of interventions and the methods used to measure adherence, we did not pool the results. Simplifying dosing regimens increased adherence in seven out of nine studies, with a relative increase in adherence of 8 per cent to 19.6 per cent. Motivational strategies were successful in 10 out of 24 studies with generally small increases in adherence up to a maximum of 23 per cent. Complex interventions involving more than one technique increased adherence in eight out of 18 studies, ranging from 5 per cent to a maximum of 41 per cent. Patient education alone seemed largely unsuccessful.
REVIEWERS' CONCLUSIONS
Reducing the number of daily doses appears to be effective in increasing adherence to blood pressure lowering medication and should be tried as a first line strategy, although there is less evidence of an effect on blood pressure reduction. Some motivational strategies and complex interventions appear promising, but we need more evidence on their effect through carefully designed RCTs.
遵守促进和监督中的道德规范。
DOI：
10.1016/s0197-2456(00)00085-4
发表时间：
2000
期刊：
Controlled clinical trials
影响因子：
--
作者：
Rand,CS;Sevick,MA
通讯作者：
Sevick,MA
知情依从：共同医疗决策的需要。
DOI：
10.1016/s0197-2456(00)00084-2
发表时间：
2000
期刊：
Controlled clinical trials
影响因子：
--
作者：
Sieber,WJ;Kaplan,RM
通讯作者：
Kaplan,RM