Systematic review of randomised controlled trials of strategies to promote adherence to tuberculosis treatment
Systematic review of randomised controlled trials of strategies to promote adherence to tuberculosis treatment
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DOI：
10.1136/bmj.315.7120.1403
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发表时间：
1997-11-29
影响因子：
105.7
通讯作者：
Garner, P
中科院分区：
文献类型：
--
作者：
Volmink, J;Garner, P
目的：确定促进依从性的策略的有效性：在Medline检索(1966至1996年8月)、Cochrane试验登记(至1996年10月)和丁香(拉丁美洲文学)(1982至1996年9月)；筛选关于依从性和依从性的文章；与结核病和依从性研究的专家联系。纳入标准：促进结核病治疗或预防治疗依从性的随机或伪随机对照试验，至少有一项依从性。主要结果衡量：相对风险和分类结果效果估计的95%可信区间。结果：5项试验符合纳入标准。向不接受治疗的患者发送经测试的提示卡的相对风险为1.2(95%可信区间1.1至1.4)，非专业卫生工作者向患者提供帮助的相对风险为1.4(1.1至1.8)，向患者提供金钱奖励的相对风险为1.6(1.3至2.0)，健康教育的相对风险为1.2(1.1至1.4)，患者激励与健康教育相结合的相对风险为2.4(1.5至3.7)或1.1(1.0至1.2)，以及加强对结核病诊所工作人员的监督1.2(1.1至1.3)。没有完成直接观察治疗的试验，所有测试的干预措施都改善了依从性。根据目前的证据，尚不清楚健康教育本身是否会导致对治疗的更好坚持。结论：有可靠的证据表明，有一些具体的策略可以改善对结核病治疗的坚持，这些策略应该在卫生系统中采用，取决于它们是否适合实际情况。进一步的创新需要进行测试，以帮助找到在低收入国家有用的具体方法。评估直接观察治疗的独立效果的随机对照试验正在等待。
Objective: To determine the effectiveness of strategies to promote adherence tIdentification: Searches in Medline (1966 to August 1996), the Cochrane trials register (up to October 1996), and LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud) (1982 to September 1996); screening of references in articles on compliance and adherence; contact with experts in research on tuberculosis and adherence.Inclusion criteria: Randomised or pseudorandomised controlled trials of interventions to promote adherence with curative or preventive treatment for tuberculosis, with at least one measure of adherence.Main outcome measure: Relative risks and 95% confidence intervals for estimates of effect for categorical outcomes.Results: Five trials met the inclusion criteria. The relative risk for tested reminder cards sent to patients who defaulted on treatment was 1.2 (95% confidence interval 1.1 to 1.4), for help given to patients by lay health workers 1.4 (1.1 to 1.8), for monetary incentives offered to patients 1.6 (1.3 to 2.0), for health education 1.2 (1.1 to 1.4), for a combination of a patient incentive and health education 2.4 (1.5 to 3.7) or 1.1 (1.0 to 1.2), and for intensive supervision of staff in tuberculosis clinics 1.2 (1.1 to 1.3). There were no completed trials of directly observed treatment All of the interventions tested improved adherence. On current evidence it is unclear whether health education by itself leads to better adherence to treatmentConclusions: Reliable evidence is available to show some specific strategies improve adherence to tuberculosis treatment, and these should be adopted in health systems, depending on their appropriateness to practice circumstances. Further innovations require testing to help find specific approaches that will be useful in low income countries. Randomised controlled trials evaluating the independent effects of directly observed treatment are awaited.