Department of Pharmaceutical Sciences, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, FAFC Wentgebouw, Sorbonnelaan 16, 3584 CA, Utrecht, The Netherlands.
Int J Clin Pharm. 2012 Apr;34(2):295-311. doi: 10.1007/s11096-012-9607-5. Epub 2012 Jan 24.
Cardiovascular diseases (CVDs) are a large burden on the healthcare system. Medicines are the primary treatment for these diseases; however, adherence to therapy is low. To optimise treatment and health outcomes for patients, it is important that adherence to cardiovascular medicines is maintained at an optimal level. Therefore, identifying effective interventions to improve adherence and persistence to cardiovascular therapy is of great significance.
This paper presents a review of the literature on interventions used in the community setting which aim to improve adherence to cardiovascular medicines in patients with hypertension, dyslipidaemia, congestive heart failure or ischaemic heart disease.
Several databases (Medline, EMBASE, PsychINFO, IPA, CINAHL, Pubmed, Cochrane) were searched for studies which were published from 1979-2009, evaluated interventions intended to improve adherence to cardiovascular medicines in the community setting, had at least one measure of adherence, and consisted of an intervention and comparison/control group.
Among 36 eligible studies (consisting of 7 informational, 15 behavioural, 1 social, and 13 combined strategy interventions), 17 (1 informational, 10 behavioural, and 6 combined) reported a significant improvement in adherence and/or persistence. Behavioural interventions were the most successful. Twenty-one studies (4 informational, 9 behavioural, and 8 combined) also demonstrated improvements in clinical outcomes, though, effects were frequently variable, contradictory and not related to changes in adherence.
Several types of interventions are effective in improving adherence and/or persistence within the CVD area and in the community setting. Behavioural interventions have shown the greatest success (compared to other types of interventions); and adding informational strategies has not resulted in further improvements in adherence. Improving adherence and persistence to cardiovascular medicines is a dynamic process that is influenced by many factors, and one which requires long term multiple interventions to promote medicine taking in patients.
心血管疾病（CVDs）对医疗体系造成了巨大的负担。药物是治疗这些疾病的主要手段，但患者的治疗依从性较低。为了优化患者的治疗效果和健康状况，保持心血管药物治疗的依从性处于最佳水平非常重要。因此，确定提高心血管治疗依从性和持久性的有效干预措施具有重要意义。
本文综述了社区环境中用于提高高血压、血脂异常、充血性心力衰竭或缺血性心脏病患者对心血管药物依从性的干预措施的文献。
检索了多个数据库（Medline、EMBASE、PsychINFO、IPA、CINAHL、Pubmed、Cochrane），以寻找 1979 年至 2009 年发表的研究，这些研究评估了旨在提高社区环境中心血管药物依从性的干预措施，至少有一项依从性测量指标，且包括干预措施和对照组。
在 36 项符合条件的研究中（包括 7 项信息性、15 项行为性、1 项社会性和 13 项联合策略干预措施），有 17 项（1 项信息性、10 项行为性和 6 项联合策略）报告了在依从性和/或持久性方面的显著改善。行为干预措施最为成功。21 项研究（4 项信息性、9 项行为性和 8 项联合策略）也显示出临床结局的改善，但效果常常是可变的、矛盾的，且与依从性的变化无关。
几种类型的干预措施在改善 CVD 领域和社区环境中的依从性和/或持久性方面是有效的。行为干预措施（与其他类型的干预措施相比）显示出最大的成功；而增加信息策略并没有进一步提高依从性。提高心血管药物的依从性和持久性是一个动态的过程，受许多因素影响，需要长期进行多种干预措施来促进患者按时服药。
