Social, Statistical, and Environmental Sciences, RTI International, 3040 Cornwallis Road, Durham, NC 27709, USA.
Ann Intern Med. 2012 Dec 4;157(11):785-95. doi: 10.7326/0003-4819-157-11-201212040-00538.
Suboptimum medication adherence is common in the United States and leads to serious negative health consequences but may respond to intervention.
To assess the comparative effectiveness of patient, provider, systems, and policy interventions that aim to improve medication adherence for chronic health conditions in the United States.
Eligible peer-reviewed publications from MEDLINE and the Cochrane Library indexed through 4 June 2012 and additional studies from reference lists and technical experts.
Randomized, controlled trials of patient, provider, or systems interventions to improve adherence to long-term medications and nonrandomized studies of policy interventions to improve medication adherence.
Two investigators independently selected, extracted data from, and rated the risk of bias of relevant studies.
The evidence was synthesized separately for each clinical condition; within each condition, the type of intervention was synthesized. Two reviewers graded the strength of evidence by using established criteria. From 4124 eligible abstracts, 62 trials of patient-, provider-, or systems-level interventions evaluated 18 types of interventions; another 4 observational studies and 1 trial of policy interventions evaluated the effect of reduced medication copayments or improved prescription drug coverage. Clinical conditions amenable to multiple approaches to improving adherence include hypertension, heart failure, depression, and asthma. Interventions that improve adherence across multiple clinical conditions include policy interventions to reduce copayments or improve prescription drug coverage, systems interventions to offer case management, and patient-level educational interventions with behavioral support.
Studies were limited to adults with chronic conditions (excluding HIV, AIDS, severe mental illness, and substance abuse) in the United States. Clinical and methodological heterogeneity hindered quantitative data pooling.
Reduced out-of-pocket expenses, case management, and patient education with behavioral support all improved medication adherence for more than 1 condition. Evidence is limited on whether these approaches are broadly applicable or affect longterm medication adherence and health outcomes.
Agency for Healthcare Research and Quality.
在美国，药物治疗依从性不足较为常见，这会导致严重的负面健康后果，但可能通过干预得到改善。
评估旨在改善美国慢性病患者药物治疗依从性的患者、医护人员、医疗系统和政策干预措施的相对有效性。
通过 2012 年 6 月 4 日索引的 MEDLINE 和 Cochrane 图书馆中的合格同行评审出版物，以及参考文献列表和技术专家中的其他研究。
改善长期药物治疗依从性的患者、医护人员或医疗系统干预的随机对照试验，以及改善药物治疗依从性的政策干预的非随机研究。
两名调查员独立选择、提取相关研究的数据，并对其偏倚风险进行评估。
根据每种临床情况分别综合证据；在每种情况下，综合干预类型。两名审查员使用既定标准对证据强度进行分级。从 4124 份合格的摘要中，有 62 项患者、医护人员或医疗系统水平的干预措施试验评估了 18 种干预措施；另外 4 项观察性研究和 1 项政策干预试验评估了减少药物共付额或改善处方药覆盖范围的效果。适合采用多种方法改善依从性的临床情况包括高血压、心力衰竭、抑郁和哮喘。改善多种临床情况依从性的干预措施包括降低共付额或改善处方药覆盖范围的政策干预、提供病例管理的医疗系统干预以及具有行为支持的患者层面的教育干预。
研究仅限于美国的慢性疾病成年人（不包括 HIV、艾滋病、严重精神疾病和药物滥用）。临床和方法学的异质性阻碍了定量数据的汇总。
降低自付费用、病例管理和具有行为支持的患者教育均改善了 1 种以上疾病的药物依从性。这些方法是否广泛适用或是否会影响长期药物依从性和健康结果，证据有限。
美国医疗保健研究与质量署。
