A systematic review of approaches to improve medication adherence in homeless adults with psychiatric disorders.
A systematic review of approaches to improve medication adherence in homeless adults with psychiatric disorders.
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DOI：
10.3389/fpsyt.2023.1339801
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发表时间：
2023
影响因子：
4.7
通讯作者：
Tsai, Jack
中科院分区：
文献类型：
--
作者：
Hird, Rachel;Radhakrishnan, Rajiv;Tsai, Jack
关键词：
在美国，在患有精神障碍的无家可归者中，用药不遵守是一个严重的问题。我们进行了一项系统的回顾，以确定在患有精神障碍(包括物质使用障碍)的无家可归者中改善精神药物依从性的策略。我们检索了7个数据库(MEDLINE、Embase、mental Info、Scope us、Web of Science、CDSR和CENTER)，按标题和摘要筛选了664篇研究，然后进行全文综述。我们的纳入标准是：涉及对患有精神障碍的无家可归成年人进行干预的研究，报告了服药依从性的量化结果，并以英文发表在同行评议期刊上。我们使用自己设计的量表对每项研究中描述的策略的相对有效性进行了评级。11项同行评议的研究符合纳入本综述的标准。在这些研究中，有七种不同的方法可以改善这一人群的服药依从性。三项研究为随机对照试验(RCT)，其余为观察性研究。门诊干预措施包括自信社区治疗、手机辅助监测、定制依从性增强加上长效注射药物，以及无家可归者指定的药房诊所。居住、收容所和住院干预措施包括使用住房优先模式、改进的治疗社区和无家可归者指定的住院护理。在11项研究中，有4项研究的方法在改善服药依从性的5分制中被评为3分或更高；没有一项得到5分。在这一人群中，具有最有力证据改善用药依从性的干预措施是果断社区治疗、定制依从性增强加长效注射药物和住房优先。总体而言，关于这一主题的研究需要更严格，并将重点放在服药依从性作为这一人群的结果。这篇综述强调了几个有希望的战略，以及需要更大的随机对照试验来确定有效和多样化的方法，以改善患有精神障碍的无家可归成年人的用药依从性。
Medication non-adherence is a significant problem among homeless individuals with psychiatric disorders in the United States. We conducted a systematic review to identify strategies to improve psychiatric medication adherence among homeless individuals with psychiatric disorders, including substance use disorders. We searched seven databases (MEDLINE, Embase, PsychInfo, Scopus, Web of Science, CDSR, and CENTRAL) and screened 664 studies by title and abstract followed by full-text review. Our inclusion criteria were studies that: involved an intervention for homeless adults with psychiatric disorders, reported a quantitative outcome of medication adherence, and were published in English in a peer-reviewed journal. We rated the relative effectiveness of strategies described in each study using a self-designed scale. Eleven peer-reviewed studies met criteria for inclusion in this review. Within these studies, there were seven different approaches to improve medication adherence in this population. Three studies were randomized controlled trials (RCTs) and the remaining were observational studies. Outpatient interventions included Assertive Community Treatment, Cell Phone-Assisted Monitoring, Customized Adherence Enhancement plus Long-Acting Injectable Medications, and Homeless-Designated Pharmacy Clinics. Residential, shelter-based, and inpatient interventions included use of the Housing First model, Modified Therapeutic Communities, and Homeless-Designated Inpatient Care. The approaches described in four of the eleven studies were rated as scoring a 3 or higher on a 5-point scale of effectiveness in improving medication adherence; none received 5 points. The interventions with the strongest evidence for improving medication adherence in this population were Assertive Community Treatment, Customized Adherence Enhancement plus Long-Acting Injectable Medications, and Housing First. Overall, studies on this topic required more rigor and focus on medication adherence as an outcome in this population. This review highlights several promising strategies and the need for larger RCTs to determine effective and diverse ways to improve medication adherence among homeless adults with psychiatric disorders.
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DOI：
10.1111/j.1745-7599.2012.00756.x
发表时间：
2012-11-01
影响因子：
--
作者：
Burda, Charon;Haack, Mary;Alemi, Farrokh
通讯作者：
Alemi, Farrokh
DOI：
10.1007/s11469-012-9392-3
发表时间：
2012-10-01
影响因子：
8
作者：
Burra, Tara A.;Hwang, Stephen W.;Stergiopoulos, Vicky
通讯作者：
Stergiopoulos, Vicky
影响因子：
2.3
作者：
El Khoury, Antoine;Patel, Charmi;Bashyal, Richa
通讯作者：
Bashyal, Richa
影响因子：
3.8
作者：
Cramer, JA;Rosenheck, R
通讯作者：
Rosenheck, R
影响因子：
17.7
作者：
Folsom, DP;Hawthorne, W;Jeste, DV
通讯作者：
Jeste, DV