Krueger Kem P, Felkey Bill G, Berger Bruce A
Department of Pharmacy Care Systems, Harrison School of Pharmacy, 128 Miller Hall, Auburn University, Auburn, AL 36849, USA.
J Am Pharm Assoc (2003). 2003 Nov-Dec;43(6):668-78; quiz 678-9. doi: 10.1331/154434503322642598.
To identify the effectiveness of adherence interventions reported in the literature, to identify interventions being conducted and/or sponsored by large chain pharmacies and pharmaceutical manufacturers, and to seek input from a panel of pharmacists who address adherence issues on a daily basis as to the steps that should be taken to advance a national initiative to increase awareness of the importance of and opportunities associated with medication adherence and persistence.
Effectiveness of the adherence interventions reported in the literature.
First, a literature search was conducted using MEDLINE, International Pharmaceutical Abstracts, CINAHL, and PsycINFO. Keywords were medication or drug and compliance or adherence or persistence and control group. Second, pharmaceutical manufacturers and chain pharmacies were surveyed. Third, an advisory panel reacted to the research findings and formulated a series of action steps that could support or be part of a national initiative to increase adherence.
Reported adherence-related interventions were grouped into five categories--adherence aids, refill or follow-up reminders, regimen simplification, written and oral education, and comprehensive management. Median adherence increases ranged from 6% to 25% for these categories. Interviews with 10 chain pharmacies revealed that adherence is an important issue. Most chains have some form of adherence program in place, but current initiatives are product-focused rather than patient-focused. Interviews with 15 manufacturers revealed that they currently use a variety of adherence interventions and want to partner with pharmacies to implement and assess the initiatives. The advisory panel developed a series of action items for implementing a national adherence initiative.
Comprehensive interventions can improve adherence and are mutually beneficial for patients, pharmacies, and manufacturers. Pharmacists must be able to assess patients' adherence, identify the reasons for nonadherence, and develop patient-specific interventions. Studies have shown that the most successful interventions have some follow-up component and address the underlying reason(s) for nonadherence. Pharmacies and pharmaceutical manufacturers have tried various adherence interventions, such as patient education and refill reminders. There is a growing sense that a national adherence initiative is needed to coordinate pharmacists' efforts to address this public health problem, and the American Pharmacists Association is well positioned to take a leadership role in such efforts.
确定文献中报道的依从性干预措施的有效性，识别由大型连锁药店和制药商开展及/或赞助的干预措施，并征求一组每天处理依从性问题的药剂师对于推进一项全国性倡议的意见，该倡议旨在提高对药物依从性和持续性的重要性及相关机会的认识。
文献中报道的依从性干预措施的有效性。
首先，使用医学索引数据库（MEDLINE）、国际药学文摘数据库（International Pharmaceutical Abstracts）、护理学与健康领域数据库（CINAHL）和心理学文摘数据库（PsycINFO）进行文献检索。关键词为药物或药品以及依从性或持续性和对照组。其次，对制药商和连锁药店进行调查。第三，一个咨询小组对研究结果做出反应，并制定了一系列行动步骤，这些步骤可支持全国性的提高依从性倡议或成为该倡议的一部分。
报道的与依从性相关的干预措施分为五类——依从性辅助工具、续方或随访提醒、治疗方案简化、书面和口头教育以及综合管理。这些类别的依从性增加中位数范围为6%至25%。对10家连锁药店的访谈显示，依从性是一个重要问题。大多数连锁药店都有某种形式的依从性计划，但目前的倡议是以产品为中心而非以患者为中心。对15家制药商的访谈显示，他们目前使用各种依从性干预措施，并希望与药店合作实施和评估这些倡议。咨询小组制定了一系列实施全国依从性倡议的行动项目。
综合干预措施可提高依从性，对患者、药店和制药商均有益。药剂师必须能够评估患者的依从性，识别不依从的原因，并制定针对患者的干预措施。研究表明，最成功的干预措施有一些随访环节，并解决不依从的根本原因。药店和制药商尝试了各种依从性干预措施，如患者教育和续方提醒。人们越来越意识到需要一项全国性的依从性倡议来协调药剂师解决这一公共卫生问题的努力，而美国药剂师协会有能力在这些努力中发挥领导作用。
