Centre for Safety and Quality in Health, Faculty of Pharmaceutical Sciences, Department of Pharmacy Practice, Naresuan University, Muang, Thailand.
School of Pharmaceutical Sciences, University of Phayao, Muang, Phayao, Thailand.
BMJ Qual Saf. 2018 Nov;27(11):902-914. doi: 10.1136/bmjqs-2017-007453. Epub 2018 Apr 17.
Medication non-adherence in ambulatory care has received substantial attention in the literature, but less so as it affects acute care. Accordingly, we aimed to estimate the frequency with which non-adherence to medication contributes to hospital admissions.
We searched the Cochrane Library, EMBASE, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts and PubMed (until December 2017) to identify prospective observational studies that examined prevalence rates of hospital admissions associated with medication non-adherence. A quality assessment was performed using an expanded Crombie checklist. Data extraction covered patterns, circumstances, and patient and other key characteristics of non-adherence. Pooled estimates were obtained using a random-effect model.
Of 24 included studies, 8 were undertaken in North America, 7 from Europe, 6 from Asia and 3 from Australia. Most studies (79%) were rated as low risk of bias. All but three studies used combination measures to detect non-adherence, but approaches to assess preventability varied considerably. Across the studies, there was high heterogeneity among prevalence estimates (χ=548, df 23, p<0.001, I=95.8%). The median prevalence rate of hospital admissions associated with non-adherence was 4.29% (IQR 3.22%-7.49%), with prevalence rates ranging from 0.72% to 10.79%. By definition, almost all of these admissions were considered preventable. The underlying causes contributing to these admissions included medication cost and side effects, and non-adherence most often involved cardiovascular medicines.
Hospital admissions associated with non-adherence to medication are a common problem. This systematic review highlights important targets for intervention. Greater attention could be focused on adherence to medication during the hospital stay as part of an enhanced medication reconciliation process. Standardisation in study methods and definitions is needed to allow future comparisons among settings; future studies should also encompass emerging economies.
在门诊护理中，药物不依从已受到文献的广泛关注，但在急性护理中却关注较少。因此，我们旨在估计药物不依从导致住院的频率。
我们检索了 Cochrane 图书馆、EMBASE、护理与联合健康文献累积索引、国际药学文摘和 PubMed（截至 2017 年 12 月），以确定前瞻性观察性研究，这些研究检查了与药物不依从相关的住院率。使用扩展的 Crombie 清单进行质量评估。数据提取涵盖了不依从的模式、情况以及患者和其他关键特征。使用随机效应模型获得汇总估计值。
24 项纳入的研究中，8 项在北美进行，7 项在欧洲进行，6 项在亚洲进行，3 项在澳大利亚进行。大多数研究（79%）被评为低偏倚风险。除了三项研究外，所有研究都使用组合措施来检测不依从性，但评估可预防的方法差异很大。在所有研究中，流行率估计值存在很高的异质性（χ=548，df 23，p<0.001，I=95.8%）。与不依从相关的住院率中位数为 4.29%（IQR 3.22%-7.49%），流行率范围为 0.72%-10.79%。根据定义，这些住院几乎都是可以预防的。导致这些住院的根本原因包括药物费用和副作用，不依从最常涉及心血管药物。
与药物不依从相关的住院是一个常见的问题。本系统评价突出了干预的重要目标。在增强药物重整过程中，应更加关注住院期间的药物依从性。需要在研究方法和定义方面进行标准化，以便在不同环境下进行未来比较；未来的研究还应包括新兴经济体。
