A meta-analysis of cognitive-based behaviour change techniques as interventions to improve medication adherence.
A meta-analysis of cognitive-based behaviour change techniques as interventions to improve medication adherence.
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DOI：
10.1136/bmjopen-2013-002749
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发表时间：
2013-08-09
期刊：
影响因子：
2.9
通讯作者：
Bhattacharya D
中科院分区：
文献类型：
--
作者：
Easthall C;Song F;Bhattacharya D
描述和评估基于认知的行为改变技术作为改善药物依从性的干预措施的使用。对提高药物依从性的干预措施进行系统回顾和荟萃分析。检索最早年份至 2013 年 4 月的 MEDLINE、EMBASE、PsycINFO、CINAHL 和 The Cochrane 图书馆数据库，无语言限制。还筛选了纳入研究的参考文献，以识别更多相关文章。我们使用预定义的标准来选择描述使用动机访谈（MI）或其他基于认知的技术的药物依从性干预的随机对照试验。两名独立评审员提取数据并评估偏倚风险。我们使用随机效应模型和 Hedges g 作为效应大小的度量进行荟萃分析。我们在荟萃分析中纳入了 26 项研究（5216 名参与者）。最常用的干预措施是心肌梗死，但许多使用的技术例如旨在提高患者的信心和自我效能感、鼓励寻求支持的行为和挑战消极想法，这些技术没有具体分类。干预措施最常见的是由全科医生和护士等常规医疗保健提供者在社区环境中提供的。计算得出的效应大小（95% CI）为 0.34（0.23 至 0.46），并且具有统计学显着性（p<0.001）。异质性很高，I2 值为 68%。对发表偏倚的调整产生了更保守的汇总效应大小估计为 0.21（0.08 至 0.33）。大多数亚组分析产生的结果在统计上不显着。基于认知的行为改变技术是有效的干预措施，可以改善药物依从性，其效果可能比当前实践中广泛使用的行为和教育干预措施更大。亚组分析表明，这些干预措施适合在不同人群中以不同方式使用，而不会丧失疗效。这些因素可能有助于将这些技术纳入日常护理中。
To describe and evaluate the use of cognitive-based behaviour change techniques as interventions to improve medication adherence. Systematic review and meta-analysis of interventions to improve medication adherence. Search of the MEDLINE, EMBASE, PsycINFO, CINAHL and The Cochrane Library databases from the earliest year to April 2013 without language restriction. References of included studies were also screened to identify further relevant articles. We used predefined criteria to select randomised controlled trials describing a medication adherence intervention that used Motivational Interviewing (MI) or other cognitive-based techniques. Data were extracted and risk of bias was assessed by two independent reviewers. We conducted the meta-analysis using a random effects model and Hedges’ g as the measure of effect size. We included 26 studies (5216 participants) in the meta-analysis. Interventions most commonly used MI, but many used techniques such as aiming to increase the patient's confidence and sense of self-efficacy, encouraging support-seeking behaviours and challenging negative thoughts, which were not specifically categorised. Interventions were most commonly delivered from community-based settings by routine healthcare providers such as general practitioners and nurses. An effect size (95% CI) of 0.34 (0.23 to 0.46) was calculated and was statistically significant (p < 0.001). Heterogeneity was high with an I2 value of 68%. Adjustment for publication bias generated a more conservative estimate of summary effect size of 0.21 (0.08 to 0.33). The majority of subgroup analyses produced statistically non-significant results. Cognitive-based behaviour change techniques are effective interventions eliciting improvements in medication adherence that are likely to be greater than the behavioural and educational interventions largely used in current practice. Subgroup analyses suggest that these interventions are amenable to use across different populations and in differing manners without loss of efficacy. These factors may facilitate incorporation of these techniques into routine care.
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