Crawshaw Jacob, Auyeung Vivian, Ashworth Lucy, Norton Sam, Weinman John
Institute of Pharmaceutical Science, King's College London, London, UK.
School of Health Sciences, City University of London, London, UK.
Open Heart. 2017 Dec 22;4(2):e000685. doi: 10.1136/openhrt-2017-000685. eCollection 2017.
We conducted a systematic review and meta-analysis to determine the effectiveness of healthcare provider-led (HCPs) interventions to support medication adherence in patients with acute coronary syndrome (ACS). A systematic search of Cochrane Library, Medline, EMBASE, PsycINFO, Web of Science, IPA, CINAHL, ASSIA, OpenGrey, EthOS, WorldCat and PQDT was undertaken. Interventions were deemed eligible if they included adult ACS patients, were HCP-led, measured medication adherence and randomised participants to parallel groups. Intervention content was coded using the Behaviour Change Technique (BCT) Taxonomy and data were pooled for analysis using random-effects models. Our search identified 8870 records, of which 27 were eligible (23 primary studies). A meta-analysis (n=9735) revealed HCP-led interventions increased the odds of medication adherence by 54% compared to control interventions (k=23, OR 1.54, 95% CI 1.26 to 1.88, I=57.5%). After removing outliers, there was a 41% increase in the odds of medication adherence with moderate heterogeneity (k=21, OR 1.41, 95% CI 1.21 to 1.65, I=35.3%). Interventions that included phone contact yielded (k=12, OR 1.63, 95% CI 1.25 to 2.12, I=32.0%) a larger effect compared to those delivered exclusively in person. A total of 32/93 BCTs were identified across interventions (mean=4.7, SD=2.2) with 'information about health consequences' (BCT 5.1) (19/23) the most common. HCP-led interventions for ACS patients appear to have a small positive impact on medication adherence. While we were able to identify BCTs among interventions, data were insufficient to determine the impact of particular BCTs on study effectiveness.
CRD42016037706.
我们进行了一项系统综述和荟萃分析，以确定医疗服务提供者主导（HCPs）的干预措施对支持急性冠状动脉综合征（ACS）患者药物依从性的有效性。我们对Cochrane图书馆、Medline、EMBASE、PsycINFO、Web of Science、IPA、CINAHL、ASSIA、OpenGrey、EthOS、WorldCat和PQDT进行了系统检索。如果干预措施纳入成年ACS患者、由HCP主导、测量药物依从性并将参与者随机分配到平行组，则被视为符合条件。使用行为改变技术（BCT）分类法对干预内容进行编码，并使用随机效应模型汇总数据进行分析。我们的检索共识别出8870条记录，其中27条符合条件（23项原始研究）。一项荟萃分析（n = 9735）显示，与对照干预措施相比，HCP主导的干预措施使药物依从性的几率提高了54%（k = 23，OR 1.54，95% CI 1.26至1.88，I² = 57.5%）。去除异常值后，药物依从性几率提高了41%，异质性适中（k = 21，OR 1.41，95% CI 1.21至1.65，I² = 35.3%）。与仅通过面对面方式实施的干预措施相比，包括电话联系的干预措施产生的效果更大（k = 12，OR 1.63，95% CI 1.25至2.12，I² = 32.0%）。在所有干预措施中总共识别出32/93种BCT（平均值 = 4.7，标准差 = 标准差 = 2.2），其中“关于健康后果的信息”（BCT 5.1）（19/23）最为常见。HCP主导的针对ACS患者的干预措施似乎对药物依从性有微小的积极影响。虽然我们能够在干预措施中识别出BCT，但数据不足以确定特定BCT对研究有效性的影响。
PROSPERO注册号：CRD42016037706。
