a Department of Health Promotion , Collegium Medicum, Nicolaus Copernicus University , Bydgoszcz , Poland.
b Department of Cardiology and Internal Diseases , Collegium Medicum, Nicolaus Copernicus University , Bydgoszcz , Poland.
Curr Med Res Opin. 2019 Feb;35(2):341-349. doi: 10.1080/03007995.2018.1510385. Epub 2018 Sep 13.
Non-adherence to medication regimen after myocardial infarction (MI) leads to increased morbidity and mortality and generates additional cost to the healthcare system.
The aim of this systematic review was to critically discuss assessment methods of adherence to medication in patients after myocardial infarction treated with percutaneous coronary intervention and the possible application of a new self-reported questionnaire.
A systematic investigation of all published literature was conducted to minimize the risk of bias. A database search (PubMed, CENTRAL and Google Scholar databases) from January 1998 through December 2017.
Adequate assessment of patient adherence to treatment is necessary to understand the potential for adverse outcomes. Methods developed for adherence evaluation are classified as subjective and objective or as direct and indirect. Direct, objective measures reflect pharmacokinetics and include measurement of the drug or its metabolite concentration, evaluation of the presence of biological markers given with the drug and direct observation of patients' medication-taking behavior. Several indirect, objective methods are based on evaluation of the availability of prescribed medications assuming that medication is taken exactly as prescribed. Assessment of the effectiveness of treatment, both at the pharmacodynamic and clinical level, indirectly but objectively reflects adherence to treatment. Subjective methods, including patient-kept diaries, patient interviews and self-reported questionnaires, due to their simplicity, real-time feedback and low cost, are often used for adherence evaluation in clinical practice.
In spite of the availability, convenience and variety of methods, measuring adherence still remains a real challenge. Using a well designed questionnaire provides an opportunity to identify patients at increased risk of non-adherence and the obstacles impeding implementation of the treatment plan, allowing implementation of tailored interventions in order to improve patient medication-taking behavior.
心肌梗死后不遵守药物治疗方案会导致发病率和死亡率增加，并给医疗保健系统带来额外的成本。
本系统评价的目的是批判性地讨论经皮冠状动脉介入治疗后心肌梗死患者药物治疗依从性的评估方法，以及新的自我报告问卷的可能应用。
为了最大限度地降低偏倚风险，对所有已发表的文献进行了系统调查。从 1998 年 1 月至 2017 年 12 月，在 PubMed、CENTRAL 和 Google Scholar 数据库中进行了数据库搜索。
为了了解不良结局的潜在可能性，对患者治疗依从性进行充分评估是必要的。为评估依从性而制定的方法分为主观和客观或直接和间接。直接、客观的措施反映了药物代谢动力学，包括测量药物或其代谢物的浓度、评估药物伴随生物标志物的存在以及直接观察患者的用药行为。几种间接、客观的方法基于评估所规定药物的可用性，假设药物的服用完全符合规定。治疗效果的评估，无论是在药效学还是临床水平上，都间接但客观地反映了对治疗的依从性。由于其简单性、实时反馈和低成本，主观方法，包括患者保存的日记、患者访谈和自我报告问卷，常用于临床实践中的依从性评估。
尽管有多种方法，包括可用性、便利性和多样性，但测量依从性仍然是一个真正的挑战。使用设计良好的问卷可以有机会确定药物治疗依从性差的患者以及阻碍治疗计划实施的障碍，从而实施有针对性的干预措施，以改善患者的服药行为。
