Adherence influencing factors - a systematic review of systematic reviews.
Adherence influencing factors - a systematic review of systematic reviews.
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DOI：
10.1186/2049-3258-72-37
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Pieper D
中科院分区：
文献类型：
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作者：
Mathes T;Jaschinski T;Pieper D
不遵守是普遍存在的问题。坚持治疗是治疗成功和安全使用的关键。本综述(综述)的目的是确定在慢性身体状况下影响依从性的因素。对Medline和Embase进行了系统的文献检索(1990-2013年7月)。根据预先确定的纳入标准对出版物进行筛选。采用AMSTAR对研究质量进行评估。两个流程步骤都是由两名审查员独立执行的。关于研究特点和结果的相关数据由一名审查员从试行的标准化表格中提取，并由另一名审查员核对。数据由两名评价者使用标准化的量化方法进行综合。共纳入7篇系统性综述。高等教育和就业似乎对坚守有积极的影响。少数民族似乎不那么顺从。自付费用和较高的药物费用似乎对依从性有负面影响。相比之下，经济状况/收入和婚姻状况似乎对忠诚度没有影响。治疗相关因素的作用大多不清楚或无效。心力衰竭患者中只有不同用药次数呈现一种效果的趋势。衡量制度复杂性的指标始终显示出负面影响的方向。病程似乎对依从性没有影响。有一种趋势是，高龄或中年与更高的忠诚度相关。但在超过一半的评论中，其效果尚不清楚。没有明确的身体和精神共病的影响。只有一篇综述显示了精神共病的影响趋势。对于性别，影响也不清楚，因为影响方向在系统评价之间和内部是异质性的。目前的概述显示了可能对遵从性产生影响的因素。只有少数几个因素对依从性的影响是一致的。大多数因素在统计意义和/或影响方向上表现出不同的结果。然而，由于属于少数民族，失业和患者服药费用一直对服药依从性产生负面影响，这表明存在社会梯度。本文的在线版本(DOI：10.1186/2049-3258-72-37)包含补充材料，可供授权用户使用。
Non-adherence is widespread problem. Adherence is a crucial point for the success and the safe use of therapies. The objective of this overview (review of reviews) was to identify factors that influence adherence in chronic physical conditions. A systematic literature search was performed in Medline and Embase (1990 to July 2013). Publications were screened according to predefined inclusion criteria. The study quality was assessed using AMSTAR. Both process steps were carried out independently by two reviewers. Relevant data on study characteristics and results were extracted in piloted standardized tables by one reviewer and checked by a second. Data were synthesized using a standardized quantitative approach by two reviewers. Seven systematic reviews were included. Higher education and employment seem to have a positive effect on adherence. Ethnic minorities seem to be less adherent. Co-payments and higher medication cost seems to have negative effect on adherence. In contrast financial status/income and marital status seem to have no influence on adherence. The effect of therapy related factors was mostly unclear or had no effect. Only the number of different medications in heart failure patients showed the tendency of an effect. Indicators of regime complexity showed consistently a negative effect direction. Duration of disease seems to have no effect on adherence. There is the tendency that higher or middle age is associated with higher adherence. But in more than half of the reviews the effect was unclear. There is no clear effect of physical as well as mental comorbidity. Only one review showed the tendency of an effect for mental comorbidity. Also for gender the effect is not clear because the effect direction was heterogenic between and within the systematic reviews. The presented overview shows factors than can potentially have influence on adherence. Only for a few factors the influence on adherence was consistent. Most factors showed heterogeneous results regarding statistical significance and/or effect direction. However, belonging to an ethnic minority, unemployment and cost for the patient for their medications showed consistently a negative effect on adherence which indicates that there is a social gradient. The online version of this article (doi:10.1186/2049-3258-72-37) contains supplementary material, which is available to authorized users.