Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA.
J Gen Intern Med. 2011 Dec;26(12):1479-91. doi: 10.1007/s11606-011-1825-3. Epub 2011 Aug 20.
Medications are a cornerstone of the prevention and management of cardiovascular disease. Long-term medication adherence has been the subject of increasing attention in the developed world but has received little attention in resource-limited settings, where the burden of disease is particularly high and growing rapidly. To evaluate prevalence and predictors of non-adherence to cardiovascular medications in this context, we systematically reviewed the peer-reviewed literature.
We performed an electronic search of Ovid Medline, Embase and International Pharmaceutical Abstracts from 1966 to August 2010 for studies that measured adherence to cardiovascular medications in the developing world. A DerSimonian-Laird random effects method was used to pool the adherence estimates across studies. Between-study heterogeneity was estimated with an I(2) statistic and studies were stratified by disease group and the method by which adherence was assessed. Predictors of non-adherence were also examined.
Our search identified 2,353 abstracts, of which 76 studies met our inclusion criteria. Overall adherence was 57.5% (95% confidence interval [CI] 52.3% to 62.7%; I(2) 0.98) and was consistent across study subgroups. Studies that assessed adherence with pill counts reported higher levels of adherence (62.1%, 95% CI 49.7% to 73.8%; I(2) 0.83) than those using self-report (54.6%, 95% CI 47.7% to 61.5%; I(2) 0.93). Adherence did not vary by geographic region, urban vs. rural settings, or the complexity of a patient's medication regimen. The most common predictors of poor adherence included poor knowledge, negative perceptions about medication, side effects and high medication costs.
Our study indicates that adherence to cardiovascular medication in resource-limited countries is sub-optimal and appears very similar to that observed in resource-rich countries. Efforts to improve adherence in resource-limited settings should be a priority given the burden of heart disease in this context, the central role of medications in their management, and the clinical and economic consequences of non-adherence.
药物是预防和治疗心血管疾病的基石。长期用药依从性一直是发达国家关注的焦点，但在资源有限的环境中却很少受到关注，而这些地方的疾病负担特别高且增长迅速。为了评估在这种情况下心血管药物的不依从率的流行率和预测因素，我们系统地回顾了同行评议的文献。
我们在 Ovid Medline、Embase 和国际药学文摘中进行了电子检索，检索了 1966 年至 2010 年 8 月期间在发展中国家测量心血管药物依从性的研究。采用 DerSimonian-Laird 随机效应方法对研究间的依从性估计值进行合并。采用 I(2)统计量估计研究间的异质性，并按疾病组和评估依从性的方法对研究进行分层。还检查了不依从的预测因素。
我们的检索共确定了 2353 篇摘要，其中 76 项研究符合纳入标准。总体依从率为 57.5%（95%置信区间[CI] 52.3%至 62.7%；I(2)为 0.98），且在研究亚组间一致。使用药片计数评估依从性的研究报告的依从率较高（62.1%，95%CI 49.7%至 73.8%；I(2)为 0.83），而使用自我报告评估的研究报告的依从率较低（54.6%，95%CI 47.7%至 61.5%；I(2)为 0.93）。依从性不受地理区域、城市与农村环境或患者药物治疗方案的复杂性的影响。不良依从的最常见预测因素包括知识不足、对药物的负面看法、副作用和高药物费用。
我们的研究表明，资源有限国家的心血管药物依从性不理想，与资源丰富国家观察到的情况非常相似。鉴于这方面的心脏病负担、药物在其管理中的核心作用以及不依从的临床和经济后果，在资源有限的环境中努力提高依从性应成为优先事项。
