Department of Rheumatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Semin Arthritis Rheum. 2013 Aug;43(1):18-28. doi: 10.1016/j.semarthrit.2012.12.001. Epub 2013 Jan 24.
To identify factors associated with adherence to medication for rheumatoid arthritis or undifferentiated inflammatory arthritis using a systematic literature search.
PubMed, PsycINFO, EMbase and CINAHL databases were systematically searched from inception to February 2011. Articles were included if they addressed medication adherence, used a reproducible definition, determinants and its statistical relationship. Methodological quality was assessed using a quality assessment list for observational studies derived from recommendations from Sanderson et al. (2007) [12]. Resulting factors were interpreted using the Health Belief Model (HBM).
18 out of 1479 identified studies fulfilled the inclusion criteria. 64 factors were identified and grouped according to the HBM into demographic and psychosocial characteristics, cues to action and perceived benefits versus perceived barriers. The belief that the medication is necessary and DMARD use prior to the use of anti-TNF had strong evidence for a positive association with adherence. There is limited evidence for positive associations between adherence and race other than White, general cognition, satisfactory contact with the healthcare provider and the provision of adequate information from the healthcare provider. There is limited evidence for negative associations between adherence and having HMO insurance, weekly costs of TNF-I, having a busy lifestyle, receiving contradictory information or delivery of information in an insensitive manner by the rheumatologist. 18 factors were unrelated to adherence.
The strongest relation with adherence is found to be prior use of DMARDs before using anti-TNF and beliefs about the necessity of the medication. Because the last one is modifiable, this provides hope to improve adherence.
通过系统文献检索，确定与类风湿关节炎或未分化炎性关节炎药物治疗依从性相关的因素。
从建库至 2011 年 2 月，系统检索 PubMed、PsycINFO、EMbase 和 CINAHL 数据库。纳入符合以下标准的文献：讨论药物依从性、使用可重复定义、确定因素及其统计关系。使用 Sanderson 等人（2007 年）[12]提出的观察性研究质量评估清单评估方法学质量。采用健康信念模型（HBM）解释得出的因素。
在 1479 篇文献中，有 18 篇符合纳入标准。共确定了 64 个因素，并根据 HBM 分为人口统计学和社会心理特征、提示因素和感知益处与感知障碍。认为药物治疗是必要的以及在使用 TNF-I 之前使用 DMARD，与依从性呈正相关，具有较强的证据支持。除了白人种族、一般认知、与医疗保健提供者满意接触以及从医疗保健提供者那里获得足够信息外，依从性与其他种族、每周 TNF-I 费用、忙碌的生活方式、接受矛盾信息或风湿病医生以不敏感的方式提供信息之间存在正相关关系，仅有有限的证据支持。18 个因素与依从性无关。
与依从性相关性最强的是在使用抗 TNF 药物之前使用 DMARD 以及对药物治疗必要性的信念。由于后者是可以改变的，因此这为提高依从性提供了希望。
