Kuntz Jennifer L, Safford Monika M, Singh Jasvinder A, Phansalkar Shobha, Slight Sarah P, Her Qoua Liang, Lapointe Nancy Allen, Mathews Robin, O'Brien Emily, Brinkman William B, Hommel Kevin, Farmer Kevin C, Klinger Elissa, Maniam Nivethietha, Sobko Heather J, Bailey Stacy C, Cho Insook, Rumptz Maureen H, Vandermeer Meredith L, Hornbrook Mark C
Center for Health Research, Kaiser Permanente Northwest, Portland, USA.
Division Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, USA.
Patient Educ Couns. 2014 Dec;97(3):310-26. doi: 10.1016/j.pec.2014.08.021. Epub 2014 Sep 16.
Patient-centered approaches to improving medication adherence hold promise, but evidence of their effectiveness is unclear. This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains: shared decision-making, methods to enhance effective prescribing, systems for eliciting and acting on patient feedback about medication use and treatment goals, and medication-taking behavior.
We reviewed literature on interventions that fell into these domains and were published between January 2007 and May 2013. Two reviewers abstracted information and categorized studies by intervention type.
We identified 60 studies, of which 40% focused on patient education. Other intervention types included augmented pharmacy services, decision aids, shared decision-making, and clinical review of patient adherence. Medication adherence was an outcome in most (70%) of the studies, although 50% also examined patient-centered outcomes.
We identified a large number of medication management interventions that incorporated patient-centered care and improved patient outcomes. We were unable to determine whether these interventions are more effective than traditional medication adherence interventions.
Additional research is needed to identify effective and feasible approaches to incorporate patient-centeredness into the medication management processes of the current health care system, if appropriate.
以患者为中心的方法来提高药物治疗依从性具有前景，但其实效证据尚不清楚。本综述报告了围绕通过四个以患者为中心的领域改善药物管理干预措施的科学研究现状：共同决策、提高有效处方的方法、获取患者用药和治疗目标反馈并据此采取行动的系统以及服药行为。
我们回顾了2007年1月至2013年5月间发表的属于这些领域的干预措施的文献。两名评审员提取信息并按干预类型对研究进行分类。
我们确定了60项研究，其中40%侧重于患者教育。其他干预类型包括增强药房服务、决策辅助工具、共同决策以及对患者依从性的临床审查。在大多数（70%）研究中，药物治疗依从性是一个结果，不过50%的研究也考察了以患者为中心的结果。
我们确定了大量纳入以患者为中心的护理并改善患者结局的药物管理干预措施。我们无法确定这些干预措施是否比传统的药物治疗依从性干预措施更有效。
如果合适的话，需要进一步研究以确定将以患者为中心纳入当前医疗保健系统药物管理流程的有效且可行的方法。
