Burudpakdee Chakkarin, Khan Zeba M, Gala Smeet, Nanavaty Merena, Kaura Satyin
Market Access Solutions, LLC, Raritan, NJ, USA ; University of North Carolina at Charlotte, Charlotte, NC, USA.
Celgene Corporation, Summit, NJ, USA.
Patient Prefer Adherence. 2015 Mar 11;9:435-48. doi: 10.2147/PPA.S77053. eCollection 2015.
Patient adherence and persistence is important to improve outcomes in chronic conditions, including inflammatory and immunologic (I&I) diseases. Patient programs that aim at improving medication adherence or persistence play an essential role in optimizing care. This meta-analysis assessed the effectiveness of patient programs in the therapeutic area of I&I diseases.
A global systematic literature review was conducted with inclusion criteria of: patient programs in I&I diseases; published in English language between January 2008 and September 2013; and reporting measures of adherence or persistence, including medication possession ratio >80% and persistence rate. A meta-analysis was performed using a random effects model. Subgroup analyses based on the type of program was performed whenever feasible.
Of 67 studies reviewed for eligibility, a total of 17 studies qualified for inclusion in the meta-analysis. Overall, patient programs increased adherence (odds ratio [OR]=2.48, 95% confidence interval [CI]=1.68-3.64, P<0.00001) as compared with standard of care. Combination patient programs that used both informational and behavioral strategies were superior in improving adherence (OR=3.68, 95% CI=2.20-6.16, P<0.00001) compared with programs that used only informational (OR=2.16, 95% CI=1.36-3.44, P=0.001) or only behavioral approaches (OR=1.85, 95% CI=1.00-3.45, P=0.05). Additionally, patients were more likely to be persistent (OR=2.26, 95% CI=1.16-4.39, P=0.02) in the intervention group as compared with the control group. Persistence (in days) was significantly (P=0.007) longer, by 42 additional days, in the intervention group than in the control group.
Patient programs can significantly improve adherence as well as persistence in the therapeutic area of I&I diseases. Programs employing a multimodal approach are more effective in improving adherence than programs with informational or behavioral strategies alone. This in turn may improve patient outcomes.
患者的依从性和持续性对于改善慢性病（包括炎症性和免疫性疾病）的治疗效果至关重要。旨在提高药物依从性或持续性的患者项目在优化治疗中发挥着重要作用。本荟萃分析评估了患者项目在炎症性和免疫性疾病治疗领域的有效性。
进行了一项全球系统性文献综述，纳入标准为：炎症性和免疫性疾病的患者项目；2008年1月至2013年9月期间以英文发表；报告依从性或持续性的指标，包括药物持有率>80%和持续率。使用随机效应模型进行荟萃分析。只要可行，就根据项目类型进行亚组分析。
在审查的67项符合资格的研究中，共有17项研究符合纳入荟萃分析的条件。总体而言，与标准治疗相比，患者项目提高了依从性（优势比[OR]=2.48，95%置信区间[CI]=1.68 - 3.64，P<0.00001）。与仅采用信息策略（OR=2.16，95% CI=1.36 - 3.44，P=0.001）或仅采用行为方法（OR=1.85，95% CI=1.00 - 3.45，P=0.05）的项目相比，同时采用信息和行为策略的联合患者项目在提高依从性方面更具优势（OR=3.68，95% CI=2.20 - 6.16，P<0.00001）。此外，与对照组相比，干预组患者更有可能保持持续性（OR=2.26，95% CI=1.16 - 4.39，P=0.02）。干预组的持续时间（天数）比对照组显著延长（P=0.007），多出42天。
患者项目可显著提高炎症性和免疫性疾病治疗领域的依从性以及持续性。采用多模式方法的项目在提高依从性方面比仅采用信息或行为策略的项目更有效。这反过来可能改善患者的治疗效果。
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