Nosè Michela, Barbui Corrado
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria, Università di Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134 Verona.
Epidemiol Psichiatr Soc. 2003 Oct-Dec;12(4):272-86. doi: 10.1017/s1121189x00003080.
Studies investigating the efficacy of clinical interventions for reducing treatment non-adherence have generated contrasting findings, and treatment non-adherence remains very common in clinical practice. This systematic review was carried out to investigate the efficacy of clinical interventions that community psychiatric services can implement to reduce non-adherence in patients with psychosis.
Systematic review of randomised clinical trials, controlled clinical trials and observational studies assessing the efficacy of adherence enhancing interventions.
Forty-seven studies met the inclusion criteria and were included in this systematic review. Data suitable for re-analysis were reported in 24 studies; from the remaining 23 studies, with no data suitable for re-analysis, outcome data were extracted according to what study authors reported. In the group of studies included in the meta-analysis educational and psychotherapeutic interventions were more effective than usual care in reducing patient non-adherence. The remaining 23 studies reported contrasting findings regarding the efficacy of educational strategies. Case management models improved the adherence in half of studies, while other interventions were effective in the majority of studies reported.
Community psychiatric services can arrange effective clinical interventions, backed by scientific evidence, for reducing patient non-adherence.
研究临床干预措施对降低治疗不依从性的疗效得出了相互矛盾的结果，且治疗不依从在临床实践中仍然非常普遍。本系统评价旨在调查社区精神科服务可实施的临床干预措施对降低精神病患者不依从性的疗效。
对评估依从性增强干预措施疗效的随机临床试验、对照临床试验和观察性研究进行系统评价。
47项研究符合纳入标准并被纳入本系统评价。24项研究报告了适合重新分析的数据；其余23项研究没有适合重新分析的数据，根据研究作者报告的内容提取了结果数据。在纳入荟萃分析的研究组中，教育和心理治疗干预在降低患者不依从性方面比常规护理更有效。其余23项研究报告了关于教育策略疗效的相互矛盾的结果。病例管理模式在一半的研究中提高了依从性，而其他干预措施在大多数报告的研究中有效。
社区精神科服务可以安排有科学证据支持的有效临床干预措施，以降低患者的不依从性。
