Heneghan C J, Glasziou P, Perera R
University of Oxford, Department of Primary Health Care, Old Road Campus, Old Road, Headington, Oxford, UK, OX3 7LF.
Cochrane Database Syst Rev. 2006 Jan 25(1):CD005025. doi: 10.1002/14651858.CD005025.pub2.
Current methods of improving medication adherence for health problems are mostly complex, labour-intensive, and not reliably effective. Medication 'reminder packaging' which incorporates a date or time for a medication to be taken in the packaging, can act as a reminder system to improve adherence.
The objective of this review was to determine the effects of reminder packaging to enhance patient adherence with self-administered medications taken for one month or more.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library Issue 3, 2004), MEDLINE, EMBASE, CINAHL and PsycINFO from the start of the databases to 1 September 2004. We also searched the internet, contacted packaging manufacturers, and checked abstracts from the Pharm-line database and reference lists from relevant articles. We did not apply any language restrictions.
We selected randomised controlled trials with at least 80% follow up, comparing a reminder packaging device with no device in participants taking self-administered medications for a minimum of one month.
Two reviewers independently assessed studies for inclusion, assessed quality, and extracted data from included studies. Where considered appropriate, data were combined for meta-analysis, or were reported and discussed in a narrative.
Eight studies containing data on 1,137 participants were included. Six intervention groups in four trials provided data on the percentage of pills taken. Reminder packaging showed a significant increase in the percentage of pills taken, weighted mean difference 11% (95% confidence interval (CI) 6% to 17%). Notable heterogeneity occurred among these trials I(2 )= 96.3%. Two trials provided data for the proportion of self-reported adherent patients, reporting a reduction in the intervention group which was not statistically significant, odds ratio = 0.89 (95% CI 0.56 to 1.40). No appropriate data were available for meta-analysis of different clinical outcomes, the most common of these being blood pressure (three out of eight trials). Other clinical outcomes reported were glycated haemoglobin, serum Vitamin C and E levels, and self-reported psychological symptoms (one trial each).
AUTHORS' CONCLUSIONS: Reminder packing may represent a simple method for improving adherence for patients with selected conditions examined to date. Further research is warranted to improve the design and targeting of these devices.
目前改善健康问题用药依从性的方法大多复杂、劳动强度大且效果不可靠。在包装中加入服药日期或时间的“提醒包装”可作为一种提醒系统来提高依从性。
本综述的目的是确定提醒包装对提高患者服用自我给药药物一个月或更长时间的依从性的效果。
我们检索了Cochrane对照试验中央注册库（CENTRAL）和效果综述文摘数据库（DARE）（《Cochrane图书馆》2004年第3期）、MEDLINE、EMBASE、CINAHL和PsycINFO，检索时间从各数据库建库起始至2004年9月1日。我们还搜索了互联网，联系了包装制造商，并查阅了Pharm-line数据库的摘要和相关文章的参考文献列表。我们没有设置任何语言限制。
我们选择随访率至少为80%的随机对照试验，比较提醒包装装置与未使用该装置的情况，试验参与者自我给药至少一个月。
两名评价员独立评估纳入研究，评估质量，并从纳入研究中提取数据。在认为合适的情况下，对数据进行合并以进行荟萃分析，或以叙述形式报告和讨论。
纳入八项研究，共1137名参与者的数据。四项试验中的六个干预组提供了服药百分比的数据。提醒包装显示服药百分比显著增加，加权平均差为11%（95%置信区间（CI）为6%至17%）。这些试验之间存在显著异质性，I² = 96.3%。两项试验提供了自我报告依从性患者比例的数据，报告干预组有所下降，但无统计学意义，比值比 = 0.89（95%CI为0.56至1.40）。没有可用于不同临床结局荟萃分析的合适数据，其中最常见的是血压（八项试验中有三项）。报告的其他临床结局包括糖化血红蛋白、血清维生素C和E水平以及自我报告的心理症状（各一项试验）。
提醒包装可能是一种改善迄今为止所研究特定疾病患者依从性的简单方法。有必要进一步研究以改进这些装置的设计和针对性。
