Patient adherence to medical treatment: a review of reviews
Patient adherence to medical treatment: a review of reviews
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DOI：
10.1186/1472-6963-7-55
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发表时间：
2007-04-17
影响因子：
2.8
通讯作者：
Bensing, Jozien
中科院分区：
文献类型：
--
作者：
van Dulmen, Sandra;Sluijs, Emmy;Bensing, Jozien
背景：患者不遵医嘱是一个长期存在的问题。许多提高患者依从性的干预措施都是不成功的，而且缺乏健全的理论基础。迫切需要理论和实践的创新。一种新的和有希望的方法可能是审查现有的对干预措施依从性的审查，并确定有效干预措施的基础理论。这就是我们研究的目的。方法：本研究是对1990年至2005年间发表的38篇关于依从性干预措施有效性的系统综述的综述。在Medline、Psychinfo、Embase和Cochrane图书馆进行电子文献检索。采用明确的纳入和排除标准。这项研究的范围是患者对治疗和护理部门医疗的依从性。结果：38项系统评价中有23项发现依从性干预措施的有效性存在显著差异。在四种理论方法中都发现了有效的干预措施：技术、行为、教育和多方面或复杂的干预措施。技术上的解决办法，例如简化治疗方案，经常被发现是有效的，尽管这并不适用于每一个治疗方案。总体而言，我们的研究结果表明，首先，存在有效的依从性干预措施，但没有明确的理论解释运行机制，例如技术解决方案。其次，有有效的依从性干预，这显然源于行为理论，例如激励和提醒。第三，还有其他理论模型似乎可以解释不遵守，但在改善遵守行为方面不是很有效。第四，由于许多依从性干预措施的复杂性和缺乏明确比较理论成分的研究，有希望的理论中的有效成分无法确定。结论：明确对比理论模型或其组成部分的比较研究很少。这些理论的相对权重以及旨在提高依从性的干预措施的有效成分，需要在未来的研究中进行评估。
Background: Patients' non-adherence to medical treatment remains a persistent problem. Many interventions to improve patient adherence are unsuccessful and sound theoretical foundations are lacking. Innovations in theory and practice are badly needed. A new and promising way could be to review the existing reviews of adherence to interventions and identify the underlying theories for effective interventions. That is the aim of our study.Methods: The study is a review of 38 systematic reviews of the effectiveness of adherence interventions published between 1990 and 2005. Electronic literature searches were conducted in Medline, Psychinfo, Embase and the Cochrane Library. Explicit inclusion and exclusion criteria were applied. The scope of the study is patient adherence to medical treatment in the cure and care sector.Results: Significant differences in the effectiveness of adherence interventions were found in 23 of the 38 systematic reviews. Effective interventions were found in each of four theoretical approaches to adherence interventions: technical, behavioural, educational and multi-faceted or complex interventions. Technical solutions, such as a simplification of the regimen, were often found to be effective, although that does not count for every therapeutic regimen.Overall, our results show that, firstly, there are effective adherence interventions without an explicit theoretical explanation of the operating mechanisms, for example technical solutions. Secondly, there are effective adherence interventions, which clearly stem from the behavioural theories, for example incentives and reminders. Thirdly, there are other theoretical models that seem plausible for explaining non-adherence, but not very effective in improving adherence behaviour. Fourthly, effective components within promising theories could not be identified because of the complexity of many adherence interventions and the lack of studies that explicitly compare theoretical components.Conclusion: There is a scarcity of comparative studies explicitly contrasting theoretical models or their components. The relative weight of these theories and the effective components in the interventions designed to improve adherence, need to be assessed in future studies.