Schedlbauer Angela, Davies Philippa, Fahey Tom
Division of Primary Care, School of Community Health Studies, University of Nottingham, Nottingham, UK, NG7 2RD.
Cochrane Database Syst Rev. 2010 Mar 17(3):CD004371. doi: 10.1002/14651858.CD004371.pub3.
Lipid lowering drugs are still widely underused, despite compelling evidence about their effectiveness in the treatment and prevention of cardiovascular disease. Poor patient adherence to a medication regimen is a major factor in the lack of success in treating hyperlipidaemia. In this updated review we focus on interventions which encourage patients at risk of heart disease or stroke to take lipid lowering medication regularly.
To assess the effects of interventions aimed at improved adherence to lipid lowering drugs, focusing on measures of adherence and clinical outcomes.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 1), MEDLINE, EMBASE, PsycINFO and CINAHL (March 2008). No language restrictions were applied.
Randomised controlled trials of adherence-enhancing interventions for lipid lowering medication in adults for both primary and secondary prevention of cardiovascular disease in an ambulatory setting looking at adherence, serum lipid levels, adverse effects and health outcomes. Studies were selected independently by two review authors.
Data were extracted and assessed by two review authors following criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions.
Three additional studies were found in the update and, in total, 11 studies were included in this review. The studies included interventions that caused a change in adherence ranging from -3% to 25% (decrease in adherence by 3% to increase in adherence by 25%). Patient re-enforcement and reminding was the most promising category of interventions, investigated in six trials of which four showed improved adherent behaviour of statistical significance (absolute increase: 24%, 9%, 8% and 6%). Other interventions associated with increased adherence were simplification of the drug regimen (absolute increase 11%) and patient information and education (absolute increase 13%). The methodological and analytical quality of some studies was low and results have to be considered with caution.
AUTHORS' CONCLUSIONS: At this stage, reminding patients seems the most promising intervention to increase adherence to lipid lowering drugs. The lack of a gold standard method of measuring adherence is one major barrier in adherence research. More reliable data might be achieved by newer methods of measurement, more consistency in adherence assessment and longer duration of follow up. More recent studies have started using more reliable methods for data collection but follow-up periods remain too short. Increased patient-centredness with emphasis on the patient's perspective and shared decision-making might lead to more conclusive answers when searching for tools to encourage patients to take lipid lowering medication.
尽管有确凿证据表明降脂药物在治疗和预防心血管疾病方面有效，但这类药物的使用仍普遍不足。患者对药物治疗方案依从性差是高脂血症治疗未取得成功的一个主要因素。在本次更新综述中，我们重点关注鼓励有心脏病或中风风险的患者定期服用降脂药物的干预措施。
评估旨在提高降脂药物依从性的干预措施的效果，重点关注依从性指标和临床结局。
我们检索了Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》2008年第1期）、MEDLINE、EMBASE、PsycINFO和CINAHL（2008年3月）。未设语言限制。
在门诊环境中对成人降脂药物进行增强依从性干预的随机对照试验，用于心血管疾病的一级和二级预防，观察依从性、血脂水平、不良反应和健康结局。由两位综述作者独立选择研究。
两位综述作者按照《Cochrane干预措施系统评价手册》概述的标准提取和评估数据。
在本次更新中又发现了三项研究，本综述共纳入11项研究。这些研究包括的干预措施使依从性变化范围为-3%至25%（依从性下降3%至上升25%）。患者强化和提醒是最有前景的干预类别，在六项试验中进行了研究，其中四项显示依从行为改善具有统计学意义（绝对增加：24%、9%、8%和6%）。与依从性增加相关的其他干预措施包括简化药物治疗方案（绝对增加11%）以及患者信息和教育（绝对增加13%）。一些研究的方法学和分析质量较低，结果必须谨慎看待。
现阶段，提醒患者似乎是提高降脂药物依从性最有前景的干预措施。缺乏测量依从性的金标准方法是依从性研究的一个主要障碍。通过更新的测量方法、依从性评估的更大一致性以及更长的随访期可能会获得更可靠的数据。最近的研究已开始使用更可靠的数据收集方法，但随访期仍然太短。在寻找鼓励患者服用降脂药物的工具时，增强以患者为中心，强调患者的观点和共同决策可能会得出更具决定性的答案。
