Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Unter den Linden 19-23, D-10117, Berlin, Germany.
PMV Research Group at the Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University of Cologne, Cologne, Germany.
Heart Fail Rev. 2018 Jan;23(1):63-71. doi: 10.1007/s10741-017-9656-x.
To determine and address medication non-adherence is important and may improve patient outcomes. Our aim was to perform a systematic review on the operationalization of adherence measures in patients with heart failure using claims data. We searched the MEDLINE, EMBASE, and Cochrane databases. A quality check of the full-text articles was performed using the Quality in Prognosis Studies tool. We included 28 studies. Eleven studies used the medication possession ratio, 15 the proportion of days covered, and six studies used own methods to calculate medication adherence. Almost all studies used an observation period of 1 year. Twenty-one studies considered angiotensin converting enzyme inhibitors or angiotensin receptor antagonists, 17 beta-blockers, 11 diuretics, eight mineralocorticoid receptor antagonists, six digitalis-glycosides, and six statins. Eight studies looked at single substance classes; 18 studies analyzed more than one drug class. Different assumptions for the dosage were used. In seven studies, switching within therapeutic classes was allowed. Three studies allowed stockpiling, nine studies censored hospital stays, and four studies censored death. Seventeen studies dichotomized the results, applying the cutoff ≥ 0.8 to define a patient as adherent. Eight studies analyzed adherence as a continuous value. The reporting quality of the methodology applied varied widely between studies. A gold standard is currently not available for the quantification of medication adherence in patients with chronic heart failure via claims data. To assess the methodology, the following parameters should be described: method of measurements, observation period, substances, dosing, switches, stockpiling, truncations, statistical analysis, and cutoff for adherence.
确定和解决药物不依从性很重要，可能会改善患者的预后。我们的目的是使用索赔数据对心力衰竭患者的依从性测量进行系统评价。我们搜索了 MEDLINE、EMBASE 和 Cochrane 数据库。使用预后研究质量工具对全文文章进行了质量检查。我们纳入了 28 项研究。11 项研究使用了药物持有率，15 项研究使用了覆盖率，6 项研究使用了自己的方法来计算药物依从性。几乎所有的研究都使用了 1 年的观察期。21 项研究考虑了血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂、17 项β受体阻滞剂、11 项利尿剂、8 项盐皮质激素受体拮抗剂、6 项洋地黄糖苷和 6 项他汀类药物。8 项研究关注单一药物类别；18 项研究分析了超过一种药物类别。不同的研究对剂量有不同的假设。在 7 项研究中，允许在治疗类别内换药。有 3 项研究允许囤药，9 项研究将住院时间剔除，4 项研究将死亡剔除。17 项研究将结果二分类，将≥0.8 作为定义患者依从的界限。8 项研究将依从性作为连续值进行分析。研究之间应用方法的报告质量差异很大。目前，通过索赔数据来量化慢性心力衰竭患者药物依从性还没有一个金标准。为了评估方法，应该描述以下参数：测量方法、观察期、药物、剂量、换药、囤药、截断、统计分析和依从性的界限。
