Nosé Michela, Barbui Corrado, Gray Richard, Tansella Michele
Department of Medicine and Public Health, Section of Psychiatry, University of Verona, Italy.
Br J Psychiatry. 2003 Sep;183:197-206. doi: 10.1192/bjp.183.3.197.
Studies investigating the efficacy of clinical interventions for reducing treatment non-adherence have generated contrasting findings, and treatment non-adherence remains common in clinical practice.
To systematically review whether there are effective clinical interventions that community psychiatric services can implement to reduce non-adherence.
Systematic review and meta-regression analysis of randomised controlled trials (RCTs) and controlled clinical trials (CCTs) were used to assess the efficacy of interventions to enhance adherence.
We reviewed 24 studies, more than half of which were RCTs. In 14 studies the experimental intervention was an educational programme. Five studies evaluated pre-discharge educational sessions, three studies explored the benefit of psychotherapeutic interventions and two studies looked at the effect of telephone prompts. The overall estimate of the efficacy of these interventions produced an odds ratio of 2.59 (95% CI 2.21-3.03) for dichotomous outcomes, and a standardised mean difference of 0.36 (95% CI 0.06-0.66) for continuous outcomes.
Community psychiatric services can potentially use effective clinical interventions, backed by scientific evidence, for reducing patient non-adherence.
关于临床干预措施减少治疗不依从性疗效的研究结果相互矛盾，且治疗不依从在临床实践中仍然很常见。
系统评价社区精神科服务机构是否可采用有效的临床干预措施来减少不依从性。
采用随机对照试验（RCT）和对照临床试验（CCT）的系统评价及Meta回归分析来评估提高依从性干预措施的疗效。
我们回顾了24项研究，其中超过一半为RCT。14项研究中实验性干预措施为教育项目。5项研究评估出院前教育课程，3项研究探讨心理治疗干预措施的益处，2项研究观察电话提醒的效果。这些干预措施疗效的总体估计得出二分结果的比值比为2.59（95%可信区间2.21 - 3.03），连续性结果的标准化均数差为0.36（95%可信区间0.06 - 0.66）。
社区精神科服务机构有可能采用有科学证据支持的有效临床干预措施来减少患者的不依从性。
