van Heuckelum Milou, van den Ende Cornelia H M, Houterman Anne E J, Heemskerk Charlotte P M, van Dulmen Sandra, van den Bemt Bart J F
Departments of Rheumatology and Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands.
Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.
PLoS One. 2017 Oct 9;12(10):e0185453. doi: 10.1371/journal.pone.0185453. eCollection 2017.
This study aims to assess the efficacy of Electronic Monitoring Feedback (EMF) as an intervention to improve medication adherence (i.e. dose- or full adherence) and clinical outcomes in adult patients.
A systematic search was performed in Medline, EMBASE, PsycINFO and Web of Science and reported according to the PRISMA guidelines. Randomised controlled trials (RCTs) comparing EMF with usual care were identified to systematically summarise the evidence for use of EMF in improving medication adherence and clinical outcomes. The GRADE approach was used to assess the quality of the body of evidence.
Of 9,993 initially-identified studies, ten studies (four of high-quality and six of low-quality) were included. The sample size of the studies included varied from 18 to 205 patients. Four of the six studies (66.7%) reported a significant positive effect of EMF on mean dose adherence levels, whereas a significant positive effect of EMF on mean full adherence levels was found in all of the included studies (100%, five out of five of the studies included). A significant positive effect of EMF on clinical outcomes was reported in one of the seven studies included. The overall effect of EMF on mean dose- and full adherence was positive and the overall effect of EMF on clinical outcomes was inconclusive.
Considering the positive effect of EMF on medication adherence, EMF might be a promising intervention to enhance medication adherence. However, the effect of EMF on clinical outcomes was inconclusive. Prior to implementing EMF in clinical practice, future research with high-quality studies (e.g. adequate sample sizes, follow-up periods and no interfering co-interventions) is required to examine the (long-term) efficacy of EMF.
本研究旨在评估电子监测反馈（EMF）作为一种干预措施，在改善成年患者药物依从性（即剂量依从性或完全依从性）及临床结局方面的疗效。
在Medline、EMBASE、PsycINFO和Web of Science中进行系统检索，并按照PRISMA指南进行报告。纳入比较EMF与常规护理的随机对照试验（RCT），以系统总结EMF在改善药物依从性和临床结局方面的证据。采用GRADE方法评估证据体的质量。
在最初识别的9993项研究中，纳入了10项研究（4项高质量和6项低质量）。纳入研究的样本量从18至205名患者不等。六项研究中的四项（66.7%）报告了EMF对平均剂量依从水平有显著的积极影响，而在所有纳入研究（100%，五项研究中的五项）中均发现EMF对平均完全依从水平有显著的积极影响。在纳入的七项研究中的一项报告了EMF对临床结局有显著的积极影响。EMF对平均剂量和完全依从性的总体影响为阳性，而EMF对临床结局的总体影响尚无定论。
考虑到EMF对药物依从性的积极影响，EMF可能是一种有前景的增强药物依从性的干预措施。然而，EMF对临床结局的影响尚无定论。在临床实践中实施EMF之前，需要高质量研究（如足够的样本量、随访期且无干扰性联合干预）的未来研究来检验EMF的（长期）疗效。
