Central Texas Veterans Health Care System, Temple, TX 76502, USA.
Value Health. 2013 Jul-Aug;16(5):891-900. doi: 10.1016/j.jval.2013.04.014. Epub 2013 Jul 10.
Numerous factors influencing medication adherence in chronically ill patients are well documented, but the paucity of studies concerning initial treatment course experiences represents a significant knowledge gap. As interventions targeting this crucial first phase can affect long-term adherence and outcomes, an international panel conducted a systematic literature review targeting behavioral or psychosocial risk factors.
Eligible published articles presenting primary data from 1966 to 2011 were abstracted by independent reviewers through a validated quality instrument, documenting terminology, methodological approaches, and factors associated with initial adherence problems.
We identified 865 potentially relevant publications; on full review, 24 met eligibility criteria. The mean Nichol quality score was 47.2 (range 19-74), with excellent reviewer concordance (0.966, P < 0.01). The most prevalent pharmacotherapy terminology was initial, primary, or first-fill adherence. Articles described the following factors commonly associated with initial nonadherence: patient characteristics (n = 16), medication class (n = 12), physical comorbidities (n = 12), pharmacy co-payments or medication costs (n = 12), health beliefs and provider communication (n = 5), and other issues. Few studies reported health system factors, such as pharmacy information, prescribing provider licensure, or nonpatient dynamics.
Several methodological challenges synthesizing the findings were observed. Despite implications for continued medication adherence and clinical outcomes, relatively few articles directly examined issues associated with initial adherence. Notwithstanding this lack of information, many observed factors associated with nonadherence are amenable to potential interventions, establishing a solid foundation for appropriate ongoing behaviors. Besides clarifying definitions and methodology, future research should continue investigating initial prescriptions, treatment barriers, and organizational efforts to promote better long-term adherence.
许多影响慢性病患者用药依从性的因素已有大量文献记载，但关于初始治疗过程体验的研究甚少，这是一个显著的知识空白。由于针对这一关键初始阶段的干预措施会影响长期的依从性和结果，一个国际小组对行为或社会心理危险因素进行了系统的文献回顾。
独立审查员通过一项经过验证的质量工具，对符合条件的已发表文章进行摘要，这些文章提供了 1966 年至 2011 年的主要数据，记录了术语、方法学方法以及与初始依从性问题相关的因素。
我们确定了 865 篇潜在相关的出版物；经过全面审查，有 24 篇符合入选标准。尼科尔质量评分的平均值为 47.2（范围为 19-74），审查员之间的一致性非常好（0.966，P<0.01）。最常见的药物治疗术语是初始、主要或首次服用依从性。文章描述了与初始不依从性常见相关的以下因素：患者特征（n=16）、药物类别（n=12）、身体合并症（n=12）、药房共付额或药物费用（n=12）、健康信念和提供者沟通（n=5）以及其他问题。很少有研究报告与健康系统相关的因素，如药房信息、处方提供者许可或非患者动态。
在综合研究结果时观察到了几个方法学挑战。尽管这对持续的药物依从性和临床结果有影响，但相对较少的文章直接研究与初始依从性相关的问题。尽管缺乏这些信息，但许多观察到的与不依从性相关的因素都可以通过潜在的干预措施来解决，为适当的持续行为奠定了坚实的基础。除了澄清定义和方法外，未来的研究还应继续调查初始处方、治疗障碍和组织努力，以促进更好的长期依从性。
