Horne Rob, Chapman Sarah C E, Parham Rhian, Freemantle Nick, Forbes Alastair, Cooper Vanessa
Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.
PLoS One. 2013 Dec 2;8(12):e80633. doi: 10.1371/journal.pone.0080633. eCollection 2013.
Patients' beliefs about treatment influence treatment engagement and adherence. The Necessity-Concerns Framework postulates that adherence is influenced by implicit judgements of personal need for the treatment (necessity beliefs) and concerns about the potential adverse consequences of taking it.
To assess the utility of the NCF in explaining nonadherence to prescribed medicines.
We searched EMBASE, Medline, PsycInfo, CDSR/DARE/CCT and CINAHL from January 1999 to April 2013 and handsearched reference sections from relevant articles.
Studies using the Beliefs about Medicines Questionnaire (BMQ) to examine perceptions of personal necessity for medication and concerns about potential adverse effects, in relation to a measure of adherence to medication.
Patients with long-term conditions.
Systematic review and meta-analysis of methodological quality was assessed by two independent reviewers. We pooled odds ratios for adherence using random effects models.
We identified 3777 studies, of which 94 (N = 25,072) fulfilled the inclusion criteria. Across studies, higher adherence was associated with stronger perceptions of necessity of treatment, OR = 1.742, 95% CI [1.569, 1.934], p<0.0001, and fewer Concerns about treatment, OR = 0.504, 95% CI: [0.450, 0.564], p<0.0001. These relationships remained significant when data were stratified by study size, the country in which the research was conducted and the type of adherence measure used.
Few prospective longitudinal studies using objective adherence measures were identified.
The Necessity-Concerns Framework is a useful conceptual model for understanding patients' perspectives on prescribed medicines. Taking account of patients' necessity beliefs and concerns could enhance the quality of prescribing by helping clinicians to engage patients in treatment decisions and support optimal adherence to appropriate prescriptions.
患者对治疗的信念会影响治疗参与度和依从性。必要性-担忧框架假定，依从性受对治疗个人需求的隐性判断（必要性信念）以及对服药潜在不良后果的担忧影响。
评估必要性-担忧框架在解释不依从处方药治疗方面的效用。
我们检索了1999年1月至2013年4月期间的EMBASE、Medline、PsycInfo、CDSR/DARE/CCT和CINAHL数据库，并人工检索了相关文章的参考文献部分。
使用药物信念问卷（BMQ）来考察对药物治疗个人必要性的认知以及对潜在不良反应的担忧，并与药物治疗依从性测量相关的研究。
患有长期疾病的患者。
由两名独立评审员对方法学质量进行系统评价和荟萃分析。我们使用随机效应模型汇总依从性的比值比。
我们识别出3777项研究，其中94项（N = 25,072）符合纳入标准。在各项研究中，更高的依从性与更强的治疗必要性认知相关，比值比（OR）= 1.742，95%置信区间[1.569, 1.934]，p < 0.0001；以及对治疗的担忧更少，OR = 0.504，95%置信区间：[0.450, 0.564]，p < 0.0001。当数据按研究规模、研究开展国家以及所使用的依从性测量类型进行分层时，这些关系仍然显著。
识别出的使用客观依从性测量的前瞻性纵向研究较少。
必要性-担忧框架是理解患者对处方药看法的有用概念模型。考虑患者的必要性信念和担忧可以通过帮助临床医生让患者参与治疗决策并支持对适当处方的最佳依从性来提高处方质量。
