Peterson Andrew M, Takiya Liza, Finley Rebecca
Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, 600 South 43rd Street, Philadelphia, PA 19104, USA.
Am J Health Syst Pharm. 2003 Apr 1;60(7):657-65. doi: 10.1093/ajhp/60.7.657.
The effect of tools and methods designed to enhance medication adherence that have been evaluated in randomized controlled trials was studied. A literature search was performed with MEDLINE, International Pharmaceutical Abstracts, PsychLIT, ERIC, and EMBASE for the period from 1966 to December 2000. Only randomized, controlled trials with at least 10 subjects per intervention group were included. Of 484 articles evaluated, only 61 met the criteria for the meta-analysis. Multiple interventions or study samples were identified in 23 of the articles. Each intervention was counted as a separate study, yielding 95 cohorts totaling 18,922 subjects. Of these subjects, 9,604 (51%) received interventions and 9,318 served as controls. Cohorts reported between 1990 and 1999 accounted for 53% of the sample; 56% of all cohorts were based in physician offices and 26% involved hypertensive patients. Behavioral interventions accounted for 41 cohorts (8,885 subjects), educational interventions for 22 cohorts (6,392 subjects), and combined interventions for 32 cohorts (3,645 subjects). Homogeneity of groupings and effect sizes (ESs) were calculated for each type of intervention. Overall, the data were not homogeneous, so conclusions could not be derived from the entire body of data. The educational intervention and combined intervention cohorts were nonhomogeneous (p < 0.001 and p < 0.01, respectively); however, the behavioral intervention cohort was homogeneous (Q = 42.48, d.f. = 40, p = 0.36). The overall ES for behavioral interventions was 0.07 (95% confidence interval [CI] = 0.04-0.09). There were no significant differences among the behavioral interventions. Educational interventions had an overall ES of 0.11 (95% CI = 0.06-0.15); there were no significant differences among the educational interventions. The overall ES of the combined interventions was 0.08 (95% CI = 0.04-0.12). When stratifying the combined intervention group by type of behavioral intervention, mail reminders had the largest impact (ES = 0.38). Meta-analysis of studies of interventions to improve medication adherence revealed an increase in adherence of 4-11%. No single strategy appeared to be best.
本研究探讨了在随机对照试验中评估的旨在提高药物依从性的工具和方法的效果。利用MEDLINE、国际药学文摘、PsychLIT、教育资源信息中心（ERIC）和荷兰医学文摘数据库（EMBASE）对1966年至2000年12月期间的文献进行检索。仅纳入每个干预组至少有10名受试者的随机对照试验。在评估的484篇文章中，只有61篇符合荟萃分析的标准。23篇文章中确定了多种干预措施或研究样本。每项干预措施都被视为一项单独的研究，共产生95个队列，总计18922名受试者。在这些受试者中，9604名（51%）接受了干预，9318名作为对照。1990年至1999年期间报告的队列占样本的53%；所有队列中有56%以医生办公室为基础，26%涉及高血压患者。行为干预占41个队列（8885名受试者），教育干预占22个队列（6392名受试者），联合干预占32个队列（3645名受试者）。计算每种干预类型的分组同质性和效应量（ESs）。总体而言，数据不具有同质性，因此无法从整个数据集得出结论。教育干预和联合干预队列不具有同质性（分别为p<0.001和p<0.01）；然而，行为干预队列具有同质性（Q = 42.48，自由度 = 40，p = 0.36）。行为干预的总体ES为0.07（95%置信区间[CI]=0.04 - 0.09）。行为干预之间没有显著差异。教育干预的总体ES为0.11（95%CI = 0.06 - 0.15）；教育干预之间没有显著差异。联合干预的总体ES为0.08（95%CI = 0.04 - 0.12）。按行为干预类型对联合干预组进行分层时，邮件提醒的影响最大（ES = 0.38）。对改善药物依从性的干预措施研究的荟萃分析显示依从性提高了4% - 11%。没有单一策略似乎是最佳的。
