Reardon Gregory, Kotak Sameer, Schwartz Gail F
Informagenics, LLC, Worthington, OH, USA; The Ohio State University College of Pharmacy, Columbus, OH, USA.
Patient Prefer Adherence. 2011;5:441-63. doi: 10.2147/PPA.S23780. Epub 2011 Sep 23.
This study summarizes findings from objective assessments of compliance (or adherence) and persistence with ocular hypotensive agents in patients with glaucoma and ocular hypertension.
Systematic literature review.
A PubMed and reference list search was conducted across publication years 1970-2010, using these terms and variants: "compliance," the equivalent term "adherence," and "persistence" in patients with these conditions and therapies. Summaries of selected studies were stratified by measurement method (electronic monitor, prescription fills review, medical chart review). Measures of central tendency across studies were calculated for commonly-reported compliance or persistence measures.
Fifty-eight articles met all inclusion/exclusion criteria: measurement of compliance-electronic monitoring (seven studies reported in 14 articles), measurement of compliance/ persistence-prescription records (36 studies in 38 articles), and measurement of persistence- medical chart review (six studies in six articles). From electronic monitoring, most therapy-experienced patients took medication consistently, but ≥20% met criteria for poor compliance. From prescription records, only 56% (range 37%-92%) of the days in the first therapy year could be dosed with the medication supply dispensed over this period. At 12 months from therapy start, only 31% (range 10%-68%) of new therapy users had not discontinued, and 40% (range 14%-67%) had not discontinued or changed the initial therapy. From medical chart review, only 67% (range 62%-78%) of patients remained persistent 12 months after starting therapy.
Evidence provided by this review suggests that poor compliance and persistence has been and remains a common problem for many glaucoma patients, and is especially problematic for patients new to therapy. The direction of empirical research should shift toward a greater emphasis on understanding of root causes and identification and testing of solutions for this problem.
本研究总结了对青光眼和高眼压症患者使用降眼压药物的依从性（或坚持性）和持续性进行客观评估的结果。
系统文献综述。
在1970年至2010年期间进行了PubMed及参考文献列表搜索，使用了以下术语及其变体：“依从性”、等效术语“坚持性”，以及这些病症和治疗方法患者的“持续性”。所选研究的摘要按测量方法（电子监测、处方配药审查、病历审查）进行分层。针对常见报告的依从性或持续性测量指标，计算了各研究的集中趋势指标。
58篇文章符合所有纳入/排除标准：依从性测量——电子监测（14篇文章报道了7项研究），依从性/持续性测量——处方记录（38篇文章中的36项研究），以及持续性测量——病历审查（6篇文章中的6项研究）。通过电子监测，大多数有治疗经验的患者用药持续，但≥20%的患者符合依从性差的标准。根据处方记录，在首个治疗年度中，只有56%（范围为37%-92%）的天数能够使用在此期间配发的药物供应进行给药。在治疗开始12个月时，只有31%（范围为10%-68%）的新治疗使用者未停药，40%（范围为14%-67%）未停药或未改变初始治疗方案。通过病历审查，只有67%（范围为62%-78%）的患者在开始治疗12个月后仍保持持续性。
本综述提供的证据表明，依从性差和持续性差一直是许多青光眼患者的常见问题，对于新接受治疗的患者尤其成问题。实证研究的方向应转向更加强调对根本原因的理解以及对该问题解决方案的识别和测试。
