Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, TN 37232, USA.
J Gen Intern Med. 2012 Dec;27(12):1609-17. doi: 10.1007/s11606-012-2136-z. Epub 2012 Jul 13.
Up to 50 % of patients do not take medications as prescribed. Interventions to improve adherence are needed, with an understanding of which patients benefit most.
To test the effect of two low-literacy interventions on medication adherence.
Randomized controlled trial, 2 × 2 factorial design.
Adults with coronary heart disease in an inner-city primary care clinic.
For 1 year, patients received usual care, refill reminder postcards, illustrated daily medication schedules, or both interventions.
The primary outcome was cardiovascular medication refill adherence, assessed by the cumulative medication gap (CMG). Patients with CMG<0.20 were considered adherent. We assessed the effect of the interventions overall and, post-hoc, in subgroups of interest.
Most of the 435 participants were elderly (mean age=63.7 years), African-American (91 %), and read below the 9th-grade level (78 %). Among the 420 subjects (97 %) for whom CMG could be calculated, 138 (32.9 %) had CMG<0.20 during follow-up and were considered adherent. Overall, adherence did not differ significantly across treatments: 31.2 % in usual care, 28.3 % with mailed refill reminders, 34.2 % with illustrated medication schedules, and 36.9 % with both interventions. In post-hoc analyses, illustrated medication schedules led to significantly greater odds of adherence among patients who at baseline had more than eight medications (OR=2.2; 95 % CI, 1.21 to 4.04) or low self-efficacy for managing medications (OR=2.15; 95 % CI, 1.11 to 4.16); a trend was present among patients who reported non-adherence at baseline (OR=1.89; 95 % CI, 0.99 to 3.60).
The interventions did not improve adherence overall. Illustrated medication schedules may improve adherence among patients with low self-efficacy, polypharmacy, or baseline non-adherence, though this requires confirmation.
多达 50%的患者没有按照规定服药。需要采取干预措施来提高用药依从性，并了解哪些患者受益最大。
测试两种低识字干预措施对药物依从性的影响。
随机对照试验，2×2 析因设计。
市中心初级保健诊所的成年冠心病患者。
在 1 年的时间里，患者接受常规护理、补充提醒明信片、每日用药示意图或两种干预措施。
主要结局是心血管药物补充的依从性，通过累积药物缺口（CMG）评估。CMG<0.20 的患者被认为是依从的。我们评估了干预措施的总体效果，并在后验分析中对感兴趣的亚组进行了评估。
大多数 435 名参与者年龄较大（平均年龄=63.7 岁），非洲裔美国人（91%），阅读水平低于 9 年级（78%）。在 420 名（97%）可以计算 CMG 的受试者中，有 138 名（32.9%）在随访期间 CMG<0.20，被认为是依从的。总体而言，不同治疗方法之间的依从性没有显著差异：常规护理为 31.2%，邮寄补充提醒为 28.3%，用药示意图为 34.2%，两种干预措施均为 36.9%。事后分析表明，对于基线时服用药物超过 8 种的患者（比值比=2.2；95%可信区间，1.21 至 4.04）或药物管理自我效能较低的患者（比值比=2.15；95%可信区间，1.11 至 4.16），用药示意图显著增加了他们的依从性；对于基线时报告不依从的患者（比值比=1.89；95%可信区间，0.99 至 3.60），也存在趋势。
这些干预措施并没有总体上提高依从性。用药示意图可能会提高自我效能感低、用药多或基线不依从的患者的依从性，但这需要进一步证实。
