Department of Pharmacology, University of Cologne, Department of Psychosomatics and Psychotherapy, University Hospital of Cologne.
Dtsch Arztebl Int. 2014 Jan 24;111(4):41-7. doi: 10.3238/arztebl.2014.0041.
A common problem among patients with chronic diseases is poor adherence with prescribed medication. Studies have shown that certain interventions can improve adherence and clinical outcomes.
We selectively searched the PubMed database for publications on the treatment of hypertension that contained the terms "adherence," "drug," "treatment, "outcome," "hypertension," and "randomized controlled trial."
The interventions studied were highly varied, ranging from the use of calendar blister packs to complex patient education programs. 62% of the studies that we identified documented an improvement in adherence after an intervention (median Cohen's d = 0.52). In 92% of cases, improved adherence was associated with a significant improvement in clinical end points (median Cohen's d = 0.34).
The promotion of adherence to prescribed medication is clearly desirable. Studies on the treatment of hypertension have shown that attempts to improve adherence often fail. In most studies, however, improved adherence led to better clinical outcomes. Simplification of drug regimens (e.g., reducing the number of pills taken per day) is the single most effective way to promote adherence. Moreover, the findings of studies on the treatment of hypertension and other diseases suggest that shared decision-making should be the basis of physicianpatient discussions about medication. Suitable medications can also be chosen in order to maximize safety and efficacy even if adherence is incomplete. It would also be desirable for studies on the promotion of adherence to be carried out in Germany, under the specific conditions that prevail in our national health-care system.
慢性病患者普遍存在遵医嘱服药差的问题。研究表明，某些干预措施可以提高依从性和临床结局。
我们有选择性地在 PubMed 数据库中搜索了包含“依从性”、“药物”、“治疗”、“结局”、“高血压”和“随机对照试验”等术语的高血压治疗相关文献。
所研究的干预措施差异很大，从使用日历式药盒到复杂的患者教育计划都有。我们确定的研究中有 62%记录了干预后依从性的改善（中位数 Cohen's d = 0.52）。在 92%的情况下，依从性的提高与临床终点的显著改善相关（中位数 Cohen's d = 0.34）。
促进患者遵医嘱服药显然是可取的。高血压治疗研究表明，改善依从性的尝试往往失败。然而，在大多数研究中，改善依从性导致了更好的临床结局。简化药物治疗方案（例如，减少每天服用的药丸数量）是促进依从性的最有效方法。此外，高血压和其他疾病治疗研究的结果表明，医患之间关于药物治疗的讨论应基于共同决策。即使依从性不完全，也可以选择合适的药物，以最大限度地提高安全性和疗效。在德国开展促进依从性的研究也是可取的，因为这可以根据我们国家卫生保健系统的具体情况进行。
