Conn Vicki S, Ruppar Todd M, Chase Jo-Ana D
School of Nursing, University of Missouri, S317 Sinclair Building, Columbia, MO, 65211, USA.
University of Missouri, S423 Sinclair Building, Columbia, MO, 65211, USA.
J Behav Med. 2016 Dec;39(6):1065-1075. doi: 10.1007/s10865-016-9730-1. Epub 2016 Mar 11.
This systematic review applied meta-analytic procedures to integrate primary research that examined blood pressure outcomes of medication adherence interventions. Random-effects model analysis calculated standardized mean difference effect sizes. Exploratory dichotomous and continuous moderator analyses using meta-analytic analogues of ANOVA and regression were performed. Codable data were extracted from 156 reports with 60,876 participants. The overall weighted mean difference systolic effect size was 0.235 across 161 treatment versus control comparisons. The diastolic effect size was 0.189 from 181 comparisons. Effect sizes were significantly heterogeneous. Common risks of bias included lack of allocation concealment, unmasked data collectors, and absent intention-to-treat analyses. Exploratory moderator analyses suggested that habit-based interventions may be most effective. The largest effect sizes were for interventions delivered by pharmacists. The modest magnitude effect sizes suggest future research should explore novel higher dose interventions that might address multiple levels of influence on adherence behavior.
本系统评价应用荟萃分析程序，整合了检验药物依从性干预措施血压结局的原始研究。随机效应模型分析计算了标准化平均差效应量。使用方差分析和回归的荟萃分析类似物进行了探索性二分法和连续性调节因素分析。从156份报告中提取了可编码数据，涉及60876名参与者。在161项治疗组与对照组比较中，收缩压效应量的总体加权平均差为0.235。在181项比较中，舒张压效应量为0.189。效应量存在显著异质性。常见的偏倚风险包括缺乏分配隐藏、数据收集者未设盲以及未进行意向性分析。探索性调节因素分析表明，基于习惯的干预措施可能最有效。效应量最大的是药剂师实施的干预措施。适度的效应量表明，未来的研究应探索可能解决对依从行为产生多层面影响的新型高剂量干预措施。
