van Dulmen Sandra, Sluijs Emmy, van Dijk Liset, de Ridder Denise, Heerdink Rob, Bensing Jozien
NIVEL (Netherlands Institute for Health Services Research), BN Utrecht, The Netherlands.
BMC Health Serv Res. 2007 Apr 17;7:55. doi: 10.1186/1472-6963-7-55.
Patients' non-adherence to medical treatment remains a persistent problem. Many interventions to improve patient adherence are unsuccessful and sound theoretical foundations are lacking. Innovations in theory and practice are badly needed. A new and promising way could be to review the existing reviews of adherence to interventions and identify the underlying theories for effective interventions. That is the aim of our study.
The study is a review of 38 systematic reviews of the effectiveness of adherence interventions published between 1990 and 2005. Electronic literature searches were conducted in Medline, Psychinfo, Embase and the Cochrane Library. Explicit inclusion and exclusion criteria were applied. The scope of the study is patient adherence to medical treatment in the cure and care sector.
Significant differences in the effectiveness of adherence interventions were found in 23 of the 38 systematic reviews. Effective interventions were found in each of four theoretical approaches to adherence interventions: technical, behavioural, educational and multi-faceted or complex interventions. Technical solutions, such as a simplification of the regimen, were often found to be effective, although that does not count for every therapeutic regimen.Overall, our results show that, firstly, there are effective adherence interventions without an explicit theoretical explanation of the operating mechanisms, for example technical solutions. Secondly, there are effective adherence interventions, which clearly stem from the behavioural theories, for example incentives and reminders. Thirdly, there are other theoretical models that seem plausible for explaining non-adherence, but not very effective in improving adherence behaviour. Fourthly, effective components within promising theories could not be identified because of the complexity of many adherence interventions and the lack of studies that explicitly compare theoretical components.
There is a scarcity of comparative studies explicitly contrasting theoretical models or their components. The relative weight of these theories and the effective components in the interventions designed to improve adherence, need to be assessed in future studies.
患者不坚持治疗仍是一个长期存在的问题。许多旨在提高患者依从性的干预措施并不成功，且缺乏坚实的理论基础。理论和实践方面的创新迫在眉睫。一种新的且有前景的方法可能是回顾现有的关于干预措施依从性的综述，并确定有效干预措施的潜在理论。这就是我们研究的目的。
本研究是对1990年至2005年间发表的38篇关于依从性干预措施有效性的系统综述的回顾。在Medline、Psychinfo、Embase和Cochrane图书馆进行了电子文献检索。应用了明确的纳入和排除标准。研究范围是患者在治疗和护理领域对医疗治疗的依从性。
在38篇系统综述中的23篇中发现了依从性干预措施有效性的显著差异。在依从性干预措施的四种理论方法中，每种方法都发现了有效的干预措施：技术、行为、教育以及多方面或复杂干预。技术解决方案，如简化治疗方案，常常被发现是有效的，尽管并非对每种治疗方案都有效。总体而言，我们的结果表明，首先，存在一些有效的依从性干预措施，但对其作用机制没有明确的理论解释，例如技术解决方案。其次，存在一些有效的依从性干预措施，它们明显源于行为理论，例如激励措施和提醒。第三，有其他理论模型似乎对解释不依从现象合理，但在改善依从行为方面效果不佳。第四，由于许多依从性干预措施的复杂性以及缺乏明确比较理论成分的研究，无法确定有前景理论中的有效成分。
明确对比理论模型或其组成部分的比较研究稀缺。这些理论及其在旨在提高依从性的干预措施中的有效成分的相对权重，需要在未来的研究中进行评估。
