使用给药时间简化方案（ATSP）改善心血管疾病患者的用药依从性。
Medication Adherence Improvement By Using Administration Timing Simplification Protocol (ATSP) in Cardiovascular Disease Patients.
机构信息
Department of Pharmacy, Seoul National University Hospital.
College of Pharmacy, Dongguk University Biomedi Campus.
出版信息
J Atheroscler Thromb. 2017 Aug 1;24(8):841-852. doi: 10.5551/jat.36335. Epub 2016 Nov 25.
AIMS
In chronic diseases, keeping adherence to medication is very difficult. The objective of this study was to evaluate the impact of administration timing simplification protocol (ATSP) on medication adherence and clinical parameters of cardiovascular diseases.
METHODS
210 out-patients with cardiovascular disease, who were taking two or more pills of any type of medication per day for more than one year, were enrolled and randomized. The intervention group followed the simplified administration schedule of ATSP with two main strategies: 1) moving medication from "pc" (30 minute after meal) to "stat. pc" (immediately after meal); and 2) moving medication time from "at evening" to "at morning." In contrast, the control group maintained the same medication schedule. Both patient groups were equally educated about the names and effects of the medication.
RESULTS
The intervention group had more pills than the control group with marginal statistical significance (5.1±2.3 vs 4.6±1.8, p=0.05). The total frequency of administration was significantly higher in the intervention group than that of the control group (2.9±1.0 vs 2.6±0.9, p=0.03) at the baseline. In the intervention group, the frequency was significantly decreased to 1.5±0.6 times per day after following ATSP application (p＜0.01). In both patient groups, knowledge about the medication was significantly improved by education. However, medication adherence was only improved in the intervention group. Interestingly, total cholesterol was significantly decreased in the intervention group (p＜0.01). The decrease in serum cholesterol concentration was significantly correlated with the improvement in medication adherence evaluated with Morisky Medication Adherence Scale (MMAS)-8 items (r=0.507, p＜0.01).
CONCLUSION
ATSP was shown to be an effective strategy to improve medication adherence in chronic cardiovascular disease patients.
目的
在慢性病中，坚持服药非常困难。本研究的目的是评估给药时间简化方案（ATSP）对心血管疾病患者药物依从性和临床参数的影响。
方法
共纳入 210 名患有心血管疾病的门诊患者，他们每天服用两种或两种以上的药物，每种药物的剂量超过一年。将患者随机分为两组，干预组采用简化给药时间的 ATSP，主要有两种策略：1）将药物从“餐后 30 分钟（pc）”改为“立即餐后（stat.pc）”；2）将药物时间从“晚上”改为“早上”。对照组则保持原有的药物使用时间表。两组患者都接受了关于药物名称和作用的相同教育。
结果
干预组的服药片数多于对照组，但差异无统计学意义（5.1±2.3 片比 4.6±1.8 片，p=0.05）。干预组的给药总频率明显高于对照组（2.9±1.0 次比 2.6±0.9 次，p=0.03），基线时两组差异无统计学意义。在干预组中，应用 ATSP 后给药频率显著降低至 1.5±0.6 次/天（p＜0.01）。在两组患者中，通过教育都显著提高了对药物的认识。然而，只有干预组的药物依从性得到了改善。有趣的是，干预组的总胆固醇显著降低（p＜0.01）。血清胆固醇浓度的降低与 Morisky 药物依从性量表（MMAS-8 项）评估的药物依从性改善显著相关（r=0.507，p＜0.01）。
结论
ATSP 是提高慢性心血管疾病患者药物依从性的有效策略。
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