Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah; and
Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Pediatrics. 2014 Jun;133(6):e1698-707. doi: 10.1542/peds.2013-3639. Epub 2014 May 5.
Improving medical regimen adherence is essential for maximizing the therapeutic potential of treatments for pediatric chronic illness. Health care providers are uniquely positioned to deliver adherence promotion interventions. However, no studies have summarized the effectiveness of health care provider-delivered adherence interventions. The objective of this study was to describe the effectiveness of health care provider-delivered adherence promotion interventions in improving adherence among children who have chronic illness. Data sources include PubMed, PsycINFO, CINAHL, and Scopus. Studies were included if they were randomized-controlled trials of pediatric interventions aiming to increase adherence to the primary regimen for a chronic illness and at least 1 health care provider delivered the intervention.
A total of 35 randomized-controlled studies including 4616 children were included. Greater improvements in adherence were observed immediately after health care provider-delivered interventions (d = 0.49; 95% confidence interval, 0.32 to 0.66) than at longer-term follow-up (d = 0.32; 95% confidence interval, 0.10 to 0.54). Treatment effect sizes differed across the adherence behaviors measured. There was significant heterogeneity in treatment effects; however, no moderators of treatment effectiveness were identified. This meta-analysis focused on the published literature. In addition, the majority of studies involved children who had asthma and younger children.
Health care provider-delivered interventions for children who have chronic illness can be effective in improving adherence. Gains in adherence are highest immediately after intervention. Future interventions and studies should include multiple methods of assessing adherence, include active comparators, and address long-term maintenance of adherence gains.
提高医疗方案依从性对于最大限度地发挥儿科慢性病治疗的潜力至关重要。医疗保健提供者在提供依从性促进干预措施方面具有独特的优势。然而，目前尚无研究总结医疗保健提供者提供的依从性干预措施的有效性。本研究的目的是描述医疗保健提供者提供的依从性促进干预措施在提高患有慢性病的儿童的依从性方面的有效性。数据来源包括 PubMed、PsycINFO、CINAHL 和 Scopus。如果研究是随机对照试验，旨在提高儿童对慢性病主要治疗方案的依从性，且至少有 1 名医疗保健提供者提供干预，则将其纳入研究。
共纳入 35 项随机对照研究，包括 4616 名儿童。与长期随访（d = 0.32；95%置信区间，0.10 至 0.54）相比，医疗保健提供者提供的干预措施后立即观察到依从性的改善更大（d = 0.49；95%置信区间，0.32 至 0.66）。测量的依从性行为的治疗效果大小不同。尽管存在治疗效果的显著异质性，但未确定治疗效果的调节因素。本荟萃分析侧重于已发表的文献。此外，大多数研究涉及患有哮喘和年龄较小的儿童。
针对患有慢性病的儿童的医疗保健提供者提供的干预措施可以有效提高依从性。干预后立即获得的依从性增益最高。未来的干预措施和研究应包括多种评估依从性的方法，包括使用活性对照，并解决长期维持依从性增益的问题。
