Philips Research, Eindhoven, The Netherlands.
Heart Fail Rev. 2013 Jul;18(4):409-27. doi: 10.1007/s10741-012-9321-3.
A systematic literature review was conducted to summarize the existing evidence on presumed determinants of heart failure (HF) medication adherence. The aim was to assess the evidence and provide directions for future medication adherence interventions for HF patients. Based on a search in relevant databases and a quality assessment, eleven articles were included in the review. A best evidence synthesis was used to combine the results of presumed determinants that were found more than once in the literature. Results were classified according the World Health Organization's (WHO) multidimensional adherence model. Results demonstrated a relationship between having been institutionalized in the past (including hospitalizations and nursing home visits) and higher adherence levels. This finding is related to the healthcare system dimension of the WHO model. The presumed determinants related to the other dimensions, such as social and economic factors, condition-related, therapy-related, and patient-related factors of the multidimensional adherence model all had inconsistent evidence. However, there was also an indication that patients' educational level and the number of healthcare professionals they have visited are not related to higher adherence levels. Based on the current review, HF patients who have been institutionalized in the past are more adherent to HF medication. Many other presumed determinants were investigated, but displayed inconsistent evidence. Due to the lack of evidence, it was not possible to make recommendations for future interventions.
系统文献回顾总结了心力衰竭（HF）药物治疗依从性的现有证据。目的是评估证据并为 HF 患者的未来药物治疗依从性干预提供指导。根据对相关数据库的搜索和质量评估，有 11 篇文章被纳入综述。采用最佳证据综合法对文献中多次出现的假定决定因素的结果进行了合并。结果根据世界卫生组织（WHO）多维依从模式进行了分类。结果表明，过去曾住院（包括住院和疗养院探访）与更高的依从水平之间存在关联。这一发现与 WHO 模型的医疗保健系统维度有关。与多维依从模型的其他维度相关的假定决定因素，如社会和经济因素、与病情相关的因素、与治疗相关的因素和与患者相关的因素，其证据都不一致。然而，也有迹象表明，患者的教育水平和他们就诊的医疗保健专业人员的数量与更高的依从水平无关。基于目前的综述，过去曾住院的 HF 患者对 HF 药物的依从性更高。许多其他假定的决定因素也进行了调查，但显示出不一致的证据。由于缺乏证据，无法为未来的干预措施提出建议。
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