Assawasuwannakit P, Braund R, Duffull S B
School of Pharmacy, University of Otago, Dunedin, New Zealand.
J Clin Pharm Ther. 2015 Feb;40(1):24-31. doi: 10.1111/jcpt.12219. Epub 2014 Oct 18.
Several studies have investigated factors that may influence adherence for a given disease. The influence of disease on adherence has received limited attention. Less work has been conducted to investigate the influence of other factors in conjunction with disease on adherence. The aim of this study was to determine the independent influence of disease and other factors on adherence.
A literature search was conducted to retrieve adherence studies using medication event monitoring system devices. Studies were categorized into different therapeutic areas. Only the two most commonly studied therapeutic areas were selected. Pseudopatient-level data were extracted from each study. The extracted data were analysed using a model-based meta-analysis technique. Univariate and multivariate models were developed. Model selection was based on a likelihood ratio test and visual plots.
The most commonly studied therapeutic areas were HIV and hypertension. The most commonly recorded adherence criterion was percentage of prescribed doses taken per day. Based on this adherence criterion, ultimately, 24 HIV papers and 12 hypertension papers were included for data extraction. The statistically significant factors were disease, age and dosing regimen. The independent influences of each factor on adherence were as follows: an increase in adherence of approximately 8% per 10-year increase of age, a 15-19% reduction from once to thrice daily dosing and that patients with HIV were 5% more adherent than those with hypertension.
Although the influence of disease on adherence was significant, it was of limited clinical significance in the diseases studied here. Adherence appears to improve with age and decline with more frequent dosing. Additionally, the influence of dosing regimen wanes with increasing age. These results should be treated as exploratory and require prospective assessment.
多项研究调查了可能影响特定疾病治疗依从性的因素。疾病对依从性的影响受到的关注有限。结合疾病研究其他因素对依从性影响的工作开展较少。本研究的目的是确定疾病及其他因素对依从性的独立影响。
进行文献检索以获取使用药物事件监测系统设备的依从性研究。研究按不同治疗领域分类。仅选择两个研究最普遍的治疗领域。从每项研究中提取伪患者水平的数据。使用基于模型的荟萃分析技术对提取的数据进行分析。建立单变量和多变量模型。模型选择基于似然比检验和直观图。
研究最普遍的治疗领域是艾滋病毒和高血压。最常记录的依从性标准是每日服用规定剂量的百分比。基于此依从性标准，最终纳入24篇艾滋病毒相关论文和12篇高血压相关论文进行数据提取。具有统计学意义的因素是疾病、年龄和给药方案。各因素对依从性的独立影响如下：年龄每增加10岁，依从性约增加8%；每日给药次数从一次增加到三次，依从性降低15% - 19%；艾滋病毒患者的依从性比高血压患者高5%。
尽管疾病对依从性有显著影响，但在此处研究的疾病中其临床意义有限。依从性似乎随年龄增长而提高，随给药频率增加而下降。此外，给药方案的影响随年龄增长而减弱。这些结果应视为探索性的，需要进行前瞻性评估。
