Packaging interventions to increase medication adherence: systematic review and meta-analysis.
Packaging interventions to increase medication adherence: systematic review and meta-analysis.
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DOI：
10.1185/03007995.2014.978939
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发表时间：
2015-01
影响因子：
2.3
通讯作者：
De Geest S
中科院分区：
文献类型：
--
作者：
Conn VS;Ruppar TM;Chan KC;Dunbar-Jacob J;Pepper GA;De Geest S
药物治疗依从性不足是一个普遍存在的问题，导致慢性病并发症和医疗保健支出增加。使用药盒和泡罩包装的包装干预措施已被广泛推荐用于解决药物依从性问题。这项荟萃分析综述确定了包装干预对药物依从性和健康结局的总体影响。此外，我们还测试了影响是否因干预、样本和设计特征而异。广泛的文献检索策略包括检查13个计算机化数据库和19个研究登记处、手工检索57种期刊以及作者和血统检索。合格的研究包括药盒或泡罩包装干预，以增加药物依从性。对主要研究特征和结局进行了可靠编码。随机效应分析用于计算总体效应量并进行调节剂分析。对来自52份报告的22，858名受试者的数据进行了综合。两组比较的总体平均加权标准化差异效应量为0.593（治疗组优于对照组），这与治疗组受试者71%依从性的平均值和对照组受试者63%依从性的平均值一致。我们发现使用主持人分析时，干预措施是最有效的，当他们使用泡罩包装，并在药店交付，而干预措施是不太有效的研究时，包括老年受试者和认知障碍。方法学调节分析显示，与采用自我报告措施的研究相比，在报告连续数据结局而非二分结果的研究中以及采用药房续药药物依从性措施的研究中，效应量显著更大。总体而言，荟萃分析结果支持使用包装干预措施，以有效地提高药物依从性。该研究的局限性包括排除了除药盒和泡罩包装外的包装干预措施，出版偏倚的证据，以及主要研究对健康结局和潜在有趣的调节变量（如处方药数量）的稀疏报告。
Inadequate medication adherence is a widespread problem that contributes to increase chronic disease complications and health care expenditures. Packaging interventions using pill boxes and blister packs have been widely recommended to address the medication adherence issue. This meta-analysis review determined the overall effect of packaging interventions on medication adherence and health outcomes. In addition, we tested whether effects vary depending on intervention, sample, and design characteristics. Extensive literature search strategies included examination of 13 computerized databases and 19 research registries, hand searches of 57 journal, and author and ancestry searches. Eligible studies included either pill-boxes or blister packaging interventions to increase medication adherence. Primary study characteristics and outcomes were reliably coded. Random-effects analyses were used to calculate overall effect sizes and conduct moderator analyses. Data were synthesized across 22,858 subjects from 52 reports. The overall mean weighted standardized difference effect size for two-group comparisons was 0.593 (favoring treatment over control), which is consistent with the mean of 71% adherence for treatment subjects compared to 63% among control subjects. We found using moderator analyses that interventions were most effective when they used blister packs and were delivered in pharmacies, while interventions were less effective when studies included older subjects and those with cognitive impairment. Methodological moderator analyses revealed significantly larger effect sizes in studies reporting continuous data outcomes instead of dichotomous results and in studies using pharmacy refill medication adherence measures as compared to studies with self-report measures. Overall, meta-analysis findings support the use of packaging interventions to effectively increase medication adherence. Limitations of the study include the exclusion of packaging interventions other than pill boxes and blister packs, evidence of publication bias, and primary study sparse reporting of health outcomes and potentially interesting moderating variables such as the number of prescribed medications.