药学主导的干预措施以提高成年糖尿病患者的药物依从性：系统评价和荟萃分析。
Pharmacy-led interventions to improve medication adherence among adults with diabetes: A systematic review and meta-analysis.
机构信息
Department of Health Services Research (HSR), Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands; Department of Clinical and Community Pharmacy, Center for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, University of Surabaya, 60293, Surabaya, East Java, Indonesia.
Department of Health Services Research (HSR), Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center (MUMC+), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, PO Box 616, 6200 MD, Maastricht, the Netherlands.
出版信息
Res Social Adm Pharm. 2019 Sep;15(9):1057-1067. doi: 10.1016/j.sapharm.2018.09.021. Epub 2018 Oct 3.
BACKGROUND
Control of blood glucose and a reduced risk of complications are important treatment goals in diabetes. Medication non-adherence can influence the outcome of diabetes. Involvement of a pharmacist in diabetes care might help patients to achieve better treatment outcomes. Existing literature reviews have focused on a limited number of interventions and outcome measures, and have involved different healthcare professionals. None of the previous reviews have used a standardized effect size to compare the effects of different pharmacist-led interventions and different outcome measures.
OBJECTIVE
To review pharmacist-led interventions to improve medication adherence in patients with diabetes and to assess the effectiveness of these interventions on medication adherence.
METHODS
Six databases were systematically searched between March and September 2017 for randomized controlled trials: PubMed, Cochrane library, EMBASE, CINAHL, JSTOR, and Web of Science. The outcome measures used were: medication adherence, HbA1c, fasting plasma glucose (FPG), post-prandial blood glucose (PPG), or random blood glucose (RBG). Cohen's d, a standardized effect size, enabled a comparison of studies with different outcome measures. The Cochrane risk of bias tool was used to assess the quality of the studies.
RESULTS
Fifty-nine studies were included in this review. Pharmacist-led interventions enhanced outcomes in patients with diabetes (standardized mean difference (SMD) -0.68; 95% CI -0.79, -0.58; p < 0.001). Sub-group analysis by intervention strategy, the type of intervention and outcome measures produced similar results. Further analysis showed that education, printed/digital material, training/group discussion, were more effective than other interventions.
CONCLUSION
This finding supports the role of the pharmacist in diabetes care to enhance medication adherence.
背景
控制血糖和降低并发症风险是糖尿病治疗的重要目标。药物依从性差会影响糖尿病的结果。药剂师参与糖尿病护理可能有助于患者获得更好的治疗结果。现有文献综述侧重于少数干预措施和结果测量，并涉及不同的医疗保健专业人员。以前的综述都没有使用标准化的效应大小来比较不同药剂师主导的干预措施和不同的结果测量。
目的
综述药剂师主导的干预措施，以提高糖尿病患者的药物依从性，并评估这些干预措施对药物依从性的有效性。
方法
2017 年 3 月至 9 月，系统地在六个数据库中搜索随机对照试验：PubMed、Cochrane 图书馆、EMBASE、CINAHL、JSTOR 和 Web of Science。使用的结果测量指标包括：药物依从性、HbA1c、空腹血糖（FPG）、餐后血糖（PPG）或随机血糖（RBG）。Cohen's d，一种标准化的效应大小，使不同结果测量的研究可以进行比较。使用 Cochrane 偏倚风险工具评估研究的质量。
结果
本综述共纳入 59 项研究。药剂师主导的干预措施改善了糖尿病患者的结局（标准化均数差（SMD）-0.68；95%CI-0.79，-0.58；p<0.001）。按干预策略、干预类型和结果测量进行的亚组分析得出了类似的结果。进一步分析表明，教育、印刷/数字材料、培训/小组讨论比其他干预措施更有效。
结论
这一发现支持药剂师在糖尿病护理中的作用，以提高药物依从性。
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