Zullig Leah L, Ramos Katherine, Bosworth Hayden B
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.
Department of Population Health Sciences, Duke University, Durham, NC, USA.
Curr Cardiol Rep. 2017 Sep 22;19(11):113. doi: 10.1007/s11886-017-0918-y.
The purpose of this review was to synthesize research findings from recently published randomized controlled trials (RCTs) targeting any phase of medication adherence, from initiation to discontinuation, among patients with coronary heart disease (CHD).
We identified successful strategies and promising practices for improving medication adherence among patients diagnosed with CHD. Consistent intervention strategies included the following: (1) facilitating patient-provider communication, (2) using mHealth technologies with emphasis on two-way communication, (3) providing patient education in tandem with lifestyle and behavioral counseling, and (4) providing psychosocial support. Regarding medication adherence phases, all studies examined implementation (i.e., taking medications as prescribed over time) and one also addressed treatment initiation (i.e., beginning a new medication). None identified addressed discontinuation. Studies varied by use of objective, self-report, and a combination of outcome measures with a greater number reporting only subjective measures of adherence. Key findings remained mixed in supporting specific intervention designs or delivery formats. This review addresses available data of promising practices for improving CHD medication adherence. Future studies are needed to examine intervention effectiveness, scalability, and durability of observed outcome effects.
本综述旨在综合近期发表的针对冠心病（CHD）患者从药物治疗起始到停药各个阶段依从性的随机对照试验（RCT）的研究结果。
我们确定了改善冠心病患者药物治疗依从性的成功策略和有前景的做法。一致的干预策略包括：（1）促进医患沟通；（2）使用强调双向沟通的移动健康技术；（3）结合生活方式和行为咨询提供患者教育；（4）提供心理社会支持。关于药物治疗依从性阶段，所有研究都考察了实施情况（即长期按规定服药），有一项研究还涉及治疗起始（即开始服用新药）。没有研究涉及停药阶段。研究在使用客观、自我报告以及结果测量指标组合方面存在差异，更多研究仅报告依从性的主观测量指标。在支持特定干预设计或实施形式方面，主要研究结果仍存在分歧。本综述阐述了改善冠心病药物治疗依从性的有前景做法的现有数据。未来需要开展研究以检验干预效果、可扩展性以及观察到的结果效应的持久性。
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