How can we improve adherence to blood pressure-lowering medication in ambulatory care? Systematic review of randomized controlled trials
How can we improve adherence to blood pressure-lowering medication in ambulatory care? Systematic review of randomized controlled trials
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DOI：
10.1001/archinte.164.7.722
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发表时间：
2004-04-12
影响因子：
--
通讯作者：
Ebrahim, S
中科院分区：
文献类型：
--
作者：
Schroeder, K;Fahey, T;Ebrahim, S
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。本研究的目的是确定干预措施的有效性，以提高对降血压药物的依从性。方法：我们对随机对照试验进行了系统回顾，并在 Cochrane 对照试验注册库、MEDLINE、EMBASE 和 CINAHL 中检索了 2002 年 4 月的所有语言出版物。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。 9 项研究中有 7 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%。激励策略在 24 项研究中的 10 项中取得了部分成功，依从性总体小幅提高，最多可达 23%。在 18 项研究中，有 8 项研究通过比较超过 1 种技术的复杂干预措施提高了依从性，幅度从 5% 到最高 41%。仅对患者进行教育似乎在很大程度上是不成功的。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，尽管迄今为止还没有证据表明其对降低血压有影响。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. The objective of this study was to determine the effectiveness of interventions to increase adherence to blood pressure-lowering medication.Methods: We performed a systematic review of randomized controlled trials and searched for all-language publications in the Cochrane Controlled Trials Register, MEDLINE, EMBASE, and CINAHL in April 2002.Results: We included 38 studies testing 58 different interventions and containing data on 15 519 patients. The studies were conducted in 9 countries between 1975 and 2000. The duration of follow-up ranged from 2 to 60 months. Because of 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 7 of 9 studies, with a relative increase in adherence of 8% to 19.6%. Motivational strategies were partly successful in 10 of 24 studies with generally small increases in adherence up to a maximum of 23%. Complex interventions comparing more than 1 technique increased adherence in 8 of 18 studies, ranging from 5% to a maximum of 41%. Patient education alone seemed largely unsuccessful.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 so far 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 randomized controlled trials.