McGrady M E, Ryan J L, Gutiérrez-Colina A M, Fredericks E M, Towner E K, Pai A L H
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Child Care Health Dev. 2015 Nov;41(6):789-802. doi: 10.1111/cch.12271. Epub 2015 Aug 9.
Understanding the impact of effective paediatric adherence promotion interventions on patients, families and the healthcare system is necessary to inform efforts to improve healthcare quality and control costs. Building on previous research suggesting that improving adherence may have far-reaching benefits, the objective of this study was to quantify the impact of effective adherence promotion interventions for children and adolescents with a chronic medical condition on patients, families and the healthcare system.
Authors systematically reviewed articles indexed in PubMed, PsycINFO and CINAHL to identify randomized controlled trials of paediatric adherence promotion interventions. Interventions that improved paediatric adherence and examined patient-level, family-level or healthcare system-level outcomes in children and adolescents (M age ≤ 18 years) with a chronic medical condition were included. Two authors independently extracted and classified outcome variables as patient-level (quality of life and disease-related activity restrictions), micro-level (family functioning, family conflict, caregiver quality of life, caregiver sleep interruption, caregiver days away from work and patient missed school days) or macro-level variables (emergency department visits, hospitalizations, outpatient visits and urgent care visits). Outcome variables detailed in previously published reviews (i.e. disease severity) were excluded.
Twenty studies representing 19 unique samples met inclusion criteria. An additional eight articles representing trials that did not significantly improve adherence were included in post hoc analyses. Compared with control interventions, effective paediatric adherence promotion interventions improved patient quality of life and family-level outcomes and decreased healthcare utilization among children and adolescents with a chronic medical condition.
Interdisciplinary efforts to improve healthcare quality and reduce spending among children and adolescents with a chronic medical condition may be enhanced by incorporating effective paediatric adherence promotion interventions. As relatively few chronic medical conditions were represented in included studies, future research should examine the impact of paediatric adherence promotion interventions in other populations.
了解有效的儿科依从性促进干预措施对患者、家庭和医疗保健系统的影响，对于提高医疗质量和控制成本的努力至关重要。基于先前的研究表明改善依从性可能带来深远益处，本研究的目的是量化针对患有慢性疾病的儿童和青少年的有效依从性促进干预措施对患者、家庭和医疗保健系统的影响。
作者系统地检索了PubMed、PsycINFO和CINAHL数据库中索引的文章，以识别儿科依从性促进干预措施的随机对照试验。纳入那些改善儿科依从性并研究患有慢性疾病的儿童和青少年（年龄≤18岁）的患者层面、家庭层面或医疗保健系统层面结果的干预措施。两位作者独立提取并将结果变量分类为患者层面（生活质量和与疾病相关的活动限制）、微观层面（家庭功能、家庭冲突、照顾者生活质量、照顾者睡眠中断、照顾者缺勤天数和患者缺课天数）或宏观层面变量（急诊就诊、住院、门诊就诊和紧急护理就诊）。排除先前发表的综述中详细描述的结果变量（即疾病严重程度）。
代表19个独特样本的20项研究符合纳入标准。另外8篇代表未显著改善依从性的试验的文章被纳入事后分析。与对照干预措施相比，有效的儿科依从性促进干预措施改善了患有慢性疾病的儿童和青少年的患者生活质量和家庭层面结果，并降低了医疗保健利用率。
通过纳入有效的儿科依从性促进干预措施，可能会加强跨学科努力，以提高患有慢性疾病的儿童和青少年的医疗质量并减少支出。由于纳入研究中涉及的慢性疾病相对较少，未来的研究应考察儿科依从性促进干预措施在其他人群中的影响。
