Meta-Analysis of Interventions to Improve Medication Adherence

描述(由申请人提供)：改善服药依从性干预措施的荟萃分析服药依从性不足(MA)会增加发病率、死亡率、患者和提供者的挫折感，以及医疗成本。令人震惊的持续不遵守在不同的样本中得到了一致的记录。关于干预措施有效性的科学证据对于开发可改善健康结果和降低成本的MA干预措施至关重要。对许多并购干预措施的研究得出了有时相互矛盾且往往不明确的结果。这些初步研究还没有得到定量的综合，这严重阻碍了实践和研究的进展。该项目的目的是整合有关旨在增加MA的干预措施的科学知识。该项目解决了这些具体目标：“确定有关干预措施以增加并购的研究基础的力量。”具体说明并量化干预措施对并购的影响。区分因素(例如，减少剂量或包装等干预特征，诊断或种族等参与者属性)，这些因素缓和了增加MA的干预效果。该研究小组已经在几项合成中使用了所建议的方法，包括最近在老年人随机试验中测试的MA干预的初步荟萃分析。广泛而严格的文献搜索将避免典型的有限搜索可能导致的偏见。战略包括通过计算机和手工期刊搜索，搜索祖先名单和注册数据库，审查研究生项目，审查会议/协会摘要，以及与检索到的研究的资深作者和国家卫生研究院资助的研究的主要研究人员联系。独立的数据抽取器将可靠地编码干预、方法和参与者属性。分析计划包括：D指数，以标准化效应的大小，样本大小加权计算，随机效应模型，同质性(Q)评估，出版物偏差分析(I2)，以及便利解释--通用语言效应大小和向原始度量的转换。使用回归和方差分析的荟萃分析类比进行的主持人分析将揭示哪些干预特征(例如，MA反馈、提示)与MA的较大增加相关。此外，还将审查干预效果方面的少数民族和性别差异。将对选定的主持人子集进行使用元回归的临时多变量主持人分析。该项目的主要影响将来自主持人分析，这些分析将确定哪些干预特征与最佳管理和评价结果有关。这些发现将通过综合不同的结果来改善公共健康，以帮助设计干预措施，帮助人们增加他们的MA并实现治疗目标。研究结果将通过确定尚未回答的研究问题以及科学已经解决的领域，对科学产生重大的直接影响。这项工作具有令人信服的重要性和广泛的范围，因此有必要为实现这些重要目标提供资金。 公共卫生相关性：该项目将统计总结数百项先前测试干预措施以改善用药依从性的研究的效果。这些发现将阐明哪些干预措施最有效地改善服药依从性。这项研究还将确定干预措施是否对具有特定特征的人最有效。

DESCRIPTION (provided by applicant): Meta-Analysis of Interventions to Improve Medication Adherence Inadequate medication adherence (MA) contributes to increased morbidity, mortality, patient and provider frustration, and health care costs. Alarming persistent nonadherence is consistently documented in diverse samples. Scientific evidence about the efficacy of interventions is essential to develop MA interventions that improve health outcomes and reduce costs. Research testing many MA interventions has yielded results that are sometimes conflicting and often unclear. These primary studies have not been quantitatively synthesized, which seriously impedes progress in both practice and research. This project's purpose is to integrate scientific knowledge about interventions designed to increase MA. The project addresses these specific aims: " Determine the strength of the research base about interventions to increase MA. " Specify and quantify the effect of interventions on MA. " Distinguish factors (e.g., intervention characteristics such as dose reduction or packaging, participant attributes such as diagnoses or ethnicity) that moderate the effect of interventions to increase MA. This research team has used the proposed methods in several syntheses, including a recent preliminary meta- analysis of MA interventions tested in randomized trials with older adults. An extensive and rigorous literature search will avoid the bias that typical limited searches can cause. Strategies include searches by computer and journal searches by hand, searches of ancestry lists and registries databases, reviews of graduate projects, examinations of conference/association abstracts, and contacts with senior authors on retrieved studies and principal investigators of NIH-funded studies. Independent data extractors will reliably code for intervention, methodological, and participant attributes. Analysis plans include: d-index to standardize the magnitude of effect, sample size weighted calculations, random-effects models, homogeneity (Q) assessment, publication bias analysis (I2), and to facilitate interpretation - Common Language Effect Size and conversion to original metric. Moderator analyses using meta-analysis analogues of regression and ANOVA will reveal which intervention characteristics (e.g., MA feedback, prompts) are associated with larger increases in MA. Minority and gender differences in intervention effectiveness will be examined as well. Provisional multivariate moderator analyses using meta-regression with selected subsets of moderators will be conducted. The major impact of the project will be derived from the moderator analyses which will determine which intervention characteristics are linked with the best MA outcomes. Findings will improve public health by synthesizing diverse results in order to aid the design of interventions that help people increase their MA and achieve therapeutic goals. Study findings will have a major immediate impact on science by identifying unanswered research questions as well as areas in which the science has been settled. This work's compelling importance and broad scope make funding necessary to achieve these important aims. PUBLIC HEALTH RELEVANCE: This project will statistically summarize the effects of hundreds of previous studies testing interventions to improve medication adherence. The findings will clarify which interventions work best to improve medication adherence. The study will also determine if interventions work best for people with particular characteristics.