Xu Rixiang, Xie Xuefeng, Li Shuting, Chen Xiaoyu, Wang Sheng, Hu Chengyang, Lv Xiongwen
School of Pharmacy, Anhui Medical University, Hefei, China.
Institute for Liver Disease, Anhui Medical University, Hefei, China.
Int J Pharm Pract. 2018 Aug;26(4):291-301. doi: 10.1111/ijpp.12452. Epub 2018 Apr 25.
A systematic review and meta-analysis of randomized controlled trials (RCTs) were performed to understand the effectiveness of medication adherence (MA) interventions among Chinese patients with hypertension.
A literature search was conducted with three English databases (PubMed, Web of Science and Embase) and three Chinese databases (China National Knowledge Infrastructure, Wanfang and VIP Database for Chinese Technical Periodicals) for the period from 1970 to October 2017. Only both RCTs with a minimum of 10 participants in each intervention group and Chinese patients with hypertension as participants were included. A random-effects model was applied to calculate pooled effect sizes with 95% CI. Subgroup analysis was conducted to identify potential sources of heterogeneity from duration of intervention, type of intervener, methods of intervention and sites of intervention. Funnel plots and Egger's test were used to evaluate for publication bias.
A total of 48 studies met criteria for the meta-analysis, including 14 568 participants, testing 57 independent comparisons. Overall, the effect size revealed that interventions significantly improved MA (pooled relative risk = 1.59, 95% CI: 1.43 to 1.78; pooled Cohen's d = 1.42, 95% CI: 0.976 to 1.876). Interventions were found to significantly reduce blood pressure (BP) (systolic BP: Cohen's d = -0.85, 95% CI: -1.11 to -0.60 and diastolic BP: Cohen's d = -0.73, 95% CI: -1.00 to -0.46). Longer duration of intervention gave better effectiveness. Physician as interventionist, regular follow-up visits and interventions conducted at a hospital were associated with better effectiveness.
Adherence interventions improve MA and reduce uncontrolled BP among Chinese patients with hypertension. In the future, investigators should adopt a skill set to address the problem of poor MA.
进行一项随机对照试验（RCT）的系统评价和荟萃分析，以了解药物依从性（MA）干预措施对中国高血压患者的有效性。
对1970年至2017年10月期间的三个英文数据库（PubMed、科学网和Embase）以及三个中文数据库（中国知网、万方和维普中文科技期刊数据库）进行文献检索。纳入标准为每个干预组至少有10名参与者的RCT，且参与者为中国高血压患者。采用随机效应模型计算合并效应量及95%置信区间（CI）。进行亚组分析以确定干预持续时间、干预者类型、干预方法和干预地点等潜在异质性来源。采用漏斗图和Egger检验评估发表偏倚。
共有48项研究符合荟萃分析标准，包括14568名参与者，进行了57次独立比较。总体而言，效应量显示干预措施显著提高了MA（合并相对危险度=1.59，95%CI：1.43至1.78；合并Cohen's d=1.42，95%CI：0.976至1.876）。发现干预措施显著降低了血压（收缩压：Cohen's d=-0.85，95%CI：-1.11至-0.60；舒张压：Cohen's d=-0.73，95%CI：-1.00至-0.46）。干预持续时间越长，效果越好。由医生作为干预者、定期随访以及在医院进行干预与更好的效果相关。
依从性干预可提高中国高血压患者的MA并降低血压未得到控制的情况。未来，研究人员应采用一套技能来解决MA差的问题。
