DiMatteo M Robin
Department of Psychology, University of California, Riverside, CA 92521, USA.
Med Care. 2004 Mar;42(3):200-9. doi: 10.1097/01.mlr.0000114908.90348.f9.
The literature on patient adherence to treatment includes hundreds of empirical studies. A comprehensive examination of the findings requires the organization and quantification that is possible with meta-analysis.
The goals of this research are retrieval, compilation, and averaging of adherence rates in all published empirical studies from 1948 to 1998; assessment of variation according to sample characteristics, time period of publication, measurement method, disease, and regimen; and examination of the effects on adherence of patient demographic characteristics.
We calculated a meta-analysis of 569 studies reporting adherence to medical treatment prescribed by a nonpsychiatrist physician, and 164 studies providing correlations between adherence and patients' age, gender, education, and income/socioeconomic status; group comparison and multiple regression analysis of moderators.
The average nonadherence rate is 24.8%. Controlling for intercorrelations among moderator variables, adherence is significantly higher in more recent and smaller studies and in those involving medication regimens and adult samples. The use of physical tests and self-report have respectively significant and borderline negative effects on the level of adherence, and disease severity and use of the medical record have no significant effects. Adherence is highest in HIV disease, arthritis, gastrointestinal disorders, and cancer, and lowest in pulmonary disease, diabetes, and sleep. Demographic effects on adherence are small and moderated by sample, regimen, and measurement variables.
This review offers insights into the literature on patient adherence, providing direction for future research. A focus on reliability and validity of adherence measurement and systematic study of substantive and methodologic moderators are recommended for future research on patient adherence.
关于患者治疗依从性的文献包含数百项实证研究。对这些研究结果进行全面考察需要采用荟萃分析所能实现的组织和量化方法。
本研究的目标是检索、汇编并平均1948年至1998年期间所有已发表实证研究中的依从率；根据样本特征、发表时间、测量方法、疾病及治疗方案评估差异；考察患者人口统计学特征对依从性的影响。
我们对569项报告非精神科医生所开药物治疗依从性的研究以及164项提供依从性与患者年龄、性别、教育程度及收入/社会经济地位之间相关性的研究进行了荟萃分析；对调节因素进行组间比较和多元回归分析。
平均不依从率为24.8%。在控制调节变量之间的相互关联后，在较新的、规模较小的研究以及涉及药物治疗方案和成人样本的研究中，依从性显著更高。体格检查和自我报告分别对依从性水平有显著的正向和临界负向影响，而疾病严重程度和病历使用情况则无显著影响。依从性在艾滋病、关节炎、胃肠道疾病和癌症中最高，在肺部疾病、糖尿病和睡眠障碍中最低。人口统计学因素对依从性影响较小，并受到样本、治疗方案和测量变量的调节。
本综述为患者依从性文献提供了见解，并为未来研究指明了方向。建议未来关于患者依从性研究应关注依从性测量的可靠性和有效性，以及对实质性和方法学调节因素进行系统研究。
