Medication adherence interventions for heart failure patients: A meta-analysis
Medication adherence interventions for heart failure patients: A meta-analysis
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DOI：
10.1177/1474515115571213
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发表时间：
2015-10-01
影响因子：
2.9
通讯作者：
Temple, Jonathon
中科院分区：
文献类型：
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作者：
Ruppar, Todd M.;Delgado, Janet M.;Temple, Jonathon
背景：坚持服药是心力衰竭自我护理的重要组成部分。服药依从性差会导致病情加重的比率增加，从而导致住院以及发病率和死亡率上升。
目的：本荟萃分析旨在量化改善心力衰竭药物依从性的干预措施对依从性结果的影响。
方法：综合检索方法确定了测试旨在改善心力衰竭患者药物依从性的干预措施的研究。来自符合条件的研究的数据由两名编码员独立编码，并使用随机效应荟萃分析方法进行分析。对于有足够数量比较的调节因素，使用荟萃回归和方差分析进行调节因素分析以解释研究之间的异质性。
结果：检索得到6665份潜在的研究报告。从这些研究中，我们确定了29项心力衰竭药物依从性干预措施的符合条件的治疗组与对照组比较（总样本量n = 4285）。两组比较的平均效应量（d指数）为0.29（标准误 = 0.09，p = 0.004）。调节因素分析发现，样本年龄越大，效应量越大。在欧洲或亚洲进行的研究与在北美洲进行的研究相比，以及仅专注于改变药物依从性的干预措施，其药物依从性效应量更大。针对医疗保健提供者的干预措施以及将社会支持作为干预组成部分的干预措施，其效应量较小。
结论：虽然所有研究中的药物依从性效应量是显著的，但效应较小。当仅专注于药物依从性以及试图改变患者行为而非医疗保健提供者行为时，改善心力衰竭药物依从性的方法可能最为有效。
Background: Adherence to medications is an essential part of heart failure self-care. Poor medication adherence leads to increased rates of exacerbation causing hospitalizations and increased morbidity and mortality.Aims: This meta-analysis aimed to quantify the effect of interventions to improve adherence to heart failure medications on adherence outcomes.Methods: Comprehensive search methods identified studies testing interventions designed to improve medication adherence among patients with heart failure. Data from eligible studies were independently coded by two coders and analyzed using random-effects meta-analysis methods. Moderator analyses to explain heterogeneity among the studies were conducted using meta-regression and ANOVA for moderators with sufficient numbers of comparisons.Results: Searching yielded 6665 potential study reports. From these studies, we identified 29 eligible treatment versus control comparisons of heart failure medication adherence interventions (total n=4285). The mean effect size (d-index) for two-group comparisons was 0.29 (SE=0.09, p=0.004). Moderator analyses found effect sizes were larger as samples were older. Medication adherence effect sizes were larger for studies conducted in Europe or Asia versus North America, and for interventions focused on changing only medication adherence. Smaller effect sizes were seen for interventions with components directed at health care providers, and those including social support as an intervention component.Conclusion: While the medication adherence effect size across all studies was significant, the effect was modest. Approaches to improving heart failure medication adherence may be most effective when focused on medication adherence alone, and when seeking to change behavior of patients, rather than health care provider behavior.