护士干预措施以提高出院老年患者的药物依从性：系统评价。
Nurse interventions to improve medication adherence among discharged older adults: a systematic review.
机构信息
School of Health sciences, HES-SO Valais - Wallis, University of Applied sciences Western Switzerland, Chémin de l'Agasse 6, Sion, Switzerland.
La Source, School of Nursing Sciences, University of Applied Sciences Western Switzerland, Lausanne, Switzerland.
出版信息
Age Ageing. 2017 Sep 1;46(5):747-754. doi: 10.1093/ageing/afx076.
BACKGROUND
discharged older adult inpatients are often prescribed numerous medications. However, they only take about half of their medications and many stop treatments entirely. Nurse interventions could improve medication adherence among this population.
OBJECTIVE
to conduct a systematic review of trials that assessed the effects of nursing interventions to improve medication adherence among discharged, home-dwelling and older adults.
METHOD
we conducted a systematic review according to the methods in the Cochrane Collaboration Handbook and reported results according to the PRISMA statement. We searched for controlled clinical trials (CCTs) and randomised CCTs (RCTs), published up to 8 November 2016 (using electronic databases, grey literature and hand searching), that evaluated the effects of nurse interventions conducted alone or in collaboration with other health professionals to improve medication adherence among discharged older adults. Medication adherence was defined as the extent to which a patient takes medication as prescribed.
RESULTS
out of 1,546 records identified, 82 full-text papers were evaluated and 14 studies were included-11 RCTs and 2 CCTs. Overall, 2,028 patients were included (995 in intervention groups; 1,033 in usual-care groups). Interventions were nurse-led in seven studies and nurse-collaborative in seven more. In nine studies, adherence was higher in the intervention group than in the usual-care group, with the difference reaching statistical significance in eight studies. There was no substantial difference in increased medication adherence whether interventions were nurse-led or nurse-collaborative. Four of the 14 studies were of relatively high quality.
CONCLUSION
nurse-led and nurse-collaborative interventions moderately improved adherence among discharged older adults. There is a need for large, well-designed studies using highly reliable tools for measuring medication adherence.
背景
出院的老年住院患者通常会开很多药，但他们只服用约一半的药物，许多人甚至完全停止治疗。护士的干预措施可以改善这一人群的药物依从性。
目的
系统评价评估护理干预措施对改善出院、居家和老年人群药物依从性的效果的试验。
方法
我们按照 Cochrane 协作组手册中的方法进行系统评价，并根据 PRISMA 声明报告结果。我们搜索了截止到 2016 年 11 月 8 日的对照临床试验（CCTs）和随机对照临床试验（RCTs），评估了单独或与其他卫生专业人员合作进行的护士干预措施对改善出院老年患者药物依从性的效果。药物依从性定义为患者按规定服药的程度。
结果
在 1546 条记录中，有 82 篇全文论文被评估，最终有 14 项研究被纳入，包括 11 项 RCT 和 2 项 CCT。共有 2028 名患者纳入研究（干预组 995 名，常规护理组 1033 名）。7 项研究为护士主导，7 项研究为护士协作。9 项研究中，干预组的依从性高于常规护理组，其中 8 项研究差异有统计学意义。护士主导或协作的干预措施对提高药物依从性的效果没有显著差异。14 项研究中有 4 项质量相对较高。
结论
护士主导和协作的干预措施可以适度改善出院老年患者的依从性。需要使用高度可靠的工具进行大规模、精心设计的研究，以测量药物依从性。
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