Faculty of Health, Queensland University of Technology, Brisbane, GPO 2343, QLD, 4002, Australia.
Res Social Adm Pharm. 2019 Feb;15(2):119-129. doi: 10.1016/j.sapharm.2018.04.003. Epub 2018 Apr 6.
Nonadherence to cardiovascular medicines occurs in 60% of subjects with chronic cardiovascular disease and leads to poor outcomes. In an attempt to improve adherence and cardiovascular outcomes, interventions are often used. Interventions may involve a pharmacist, but it is not always clear whether these are effective.
The primary objective of this review is to determine whether interventions by pharmacists, alone, discussing adherence to medicines, improve adherence to medicines for cardiovascular disease. Subsequently, the review links the characteristics of the individual studies with effectiveness or lack of effect. The second objective of this review is to consider whether any improvement in adherence with interventions by pharmacist is associated with better clinical outcomes.
A literature search of PubMed and CINAHL for 'pharmacist', 'medicine' with 'adherence' or 'compliance' or 'persistence' was undertaken. To be included in this review, papers had to be of a pharmacist working alone and in person in an intervention of subjects with hypertension, hyperlipidemia (prior to or after a coronary artery event) or heart failure. The paper had to be published in a peer review journal, with a measure of adherence to medicines. The effectiveness of the intervention had to be evaluated after ≥6 months.
Only 3 out of 8 interventions by pharmacists in hypertension, and 5 out of 12 interventions in subjects with hyperlipidemia led to improved adherence to medicines. In contrast, all 6 interventions by a pharmacist in subjects with heart failure were successful in improving adherence. One characteristic of successful interventions by pharmacists to improve adherence to cardiovascular medicines is that they must be more than brief/single interventions. A second characteristic is that the intervention should not involve subjects who are already highly adherent, as it is unlikely adherence can be improved in this population. Only 2 of 3 successful interventions in hypertension were associated with small reductions in blood pressure, and only one intervention in hyperlipidemia was shown to decrease LDL-cholesterol to a small extent. In subjects with heart failure, 5 of the 6 successful studies of the successful interventions by pharmacists to increase adherence also showed improved clinical outcomes.
When planning an intervention to improve adherence to medicines and cardiovascular outcomes in subjects with hypertension or hyperlipidemic, by a pharmacist alone, or as part of a multi-faceted interventions, it is essential to use an intervention that has been shown to be effective, as most interventions are not effective at improving adherence or only improve adherence and clinical outcomes to a small extent. In heart failure, there is well documented evidence of interventions by pharmacists that do improve clinical outcomes, which should be adopted widely.
在患有慢性心血管疾病的患者中，有 60%的患者存在不遵医嘱用药的情况，这会导致不良预后。为了改善用药依从性和心血管结局，通常会采用干预措施。这些干预措施可能涉及药剂师，但尚不清楚这些干预措施是否有效。
本综述的主要目的是确定药剂师单独进行的关于药物依从性的讨论干预措施是否能提高心血管疾病患者的用药依从性。随后，本综述将把个体研究的特点与有效性或缺乏有效性联系起来。本综述的第二个目的是考虑药剂师干预措施提高用药依从性是否与更好的临床结局相关。
对 PubMed 和 CINAHL 进行文献检索，检索词为“pharmacist”、“medicine”、“adherence”或“compliance”或“persistence”。本综述纳入的研究必须为单独的药剂师以面对面的方式在干预高血压、高血脂（在冠状动脉事件之前或之后）或心力衰竭患者的药物治疗依从性的研究。这些研究必须发表在同行评议的期刊上，并采用药物依从性的测量方法。干预措施的有效性必须在≥6 个月后进行评估。
在高血压患者中，有 3 项（8 项中的 3 项）药剂师干预措施，在高血脂患者中，有 5 项（12 项中的 5 项）干预措施导致了用药依从性的改善。相比之下，心力衰竭患者的 6 项（6 项中的 6 项）药剂师干预措施均成功改善了用药依从性。药剂师干预措施成功提高心血管药物治疗依从性的一个特征是，这些干预措施必须不仅仅是简单的单次干预。另一个特征是，干预措施不应该针对已经高度依从的患者，因为在这些人群中不太可能提高依从性。在高血压患者中，3 项成功的干预措施中仅有 2 项与血压的小幅降低相关，而高血脂患者中仅有 1 项干预措施显示 LDL 胆固醇有较小程度的降低。在心力衰竭患者中，药剂师干预措施成功提高用药依从性的 6 项研究中有 5 项还显示改善了临床结局。
在计划由药剂师单独或作为多方面干预措施的一部分来提高高血压或高血脂患者的用药依从性和心血管结局时，如果要采用干预措施，必须采用已被证明有效的干预措施，因为大多数干预措施并不能有效提高用药依从性，或者仅能在很小程度上提高用药依从性和临床结局。在心衰患者中，已有充分证据表明药剂师的干预措施确实可以改善临床结局，这些措施应该得到广泛采用。
