Jörntén-Karlsson Magnus, Pintat Stéphane, Molloy-Bland Michael, Berg Staffan, Ahlqvist Matti
AstraZeneca Gothenburg, Mölndal, Sweden.
Research Evaluation Unit, Oxford PharmaGenesis, Oxford, UK.
Drugs. 2016 Oct;76(15):1447-1465. doi: 10.1007/s40265-016-0640-x.
Poor adherence to statins increases cardiovascular disease risk. We systematically identified 32 controlled studies that assessed patient-centered interventions designed to improve statin adherence. The limited number of studies and variation in study characteristics precluded strict quality criteria or meta-analysis. Cognitive education or behavioural counselling delivered face-to-face multiple times consistently improved statin adherence compared with control groups (7/8 and 3/3 studies, respectively). None of four studies using medication reminders and/or adherence feedback alone reported significantly improved statin adherence. Single interventions that improved statin adherence but were not conducted face-to-face included cognitive education in the form of genetic test results (two studies) and cognitive education via a website (one study). Similar mean adherence measures were reported for 17 intervention arms and were thus compared in a sub-analysis: 8 showed significantly improved statin adherence, but effect sizes were modest (+7 to +22 % points). In three of these studies, statin adherence improved despite already being high in the control group (82-89 vs. 57-69 % in the other studies). These three studies were the only studies in this sub-analysis to include cognitive education delivered face-to-face multiple times (plus other interventions). In summary, the most consistently effective interventions for improving adherence to statins have modest effects and are resource-intensive. Research is needed to determine whether modern communications, particularly mobile health platforms (recently shown to improve medication adherence in other chronic diseases), can replicate or even enhance the successful elements of these interventions while using less time and fewer resources.
他汀类药物依从性差会增加心血管疾病风险。我们系统地检索了32项对照研究，这些研究评估了旨在提高他汀类药物依从性的以患者为中心的干预措施。研究数量有限以及研究特征的差异使得无法采用严格的质量标准或进行荟萃分析。与对照组相比，多次面对面进行的认知教育或行为咨询能持续提高他汀类药物的依从性（分别为7/8和3/3项研究）。仅使用药物提醒和/或依从性反馈的四项研究中，没有一项报告他汀类药物依从性有显著改善。能提高他汀类药物依从性但未面对面进行的单一干预措施包括以基因检测结果形式进行的认知教育（两项研究）和通过网站进行的认知教育（一项研究）。对17个干预组报告的平均依从性指标进行了比较，并在一项亚分析中进行了对比：8个干预组显示他汀类药物依从性有显著改善，但效应量较小（提高7至22个百分点）。在其中三项研究中，尽管对照组的依从性已经很高，但他汀类药物的依从性仍有所提高（对照组为82 - 89%，其他研究为57 - 69%）。这三项研究是该亚分析中仅有的包括多次面对面进行认知教育（以及其他干预措施）的研究。总之，提高他汀类药物依从性最持续有效的干预措施效果有限且资源密集。需要开展研究以确定现代通信手段，尤其是移动健康平台（最近已证明可提高其他慢性病的药物依从性）能否在使用更少时间和资源的情况下复制甚至增强这些干预措施的成功要素。
