Wilhelmsen Nina C, Eriksson Tommy
Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Department of Biomedical Sciences, Faculty of Health and Society, Malmö University, Malmö, Sweden.
Eur J Hosp Pharm. 2019 Jul;26(4):187-192. doi: 10.1136/ejhpharm-2018-001725. Epub 2018 Nov 16.
To present evidence for healthcare-provided medication adherence interventions on clinical, economic and humanistic outcomes among patients.
Literature search of systematic reviews in Medline, Embase and CINAHL (2007-2017), validation of quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses questionnaires and, finally, extraction, combination and tabulation of results for included studies.
From eight systematic reviews with medium to high AMSTAR 2 score, 37 randomised controlled studies involving 28 600 participants were extracted. Patient education and counselling showed some positive effects on medication adherence. Patient education also showed some positive effects on morbidity, healthcare utilities and patient satisfaction. Counselling had some benefit on mortality and healthcare utilisation. Simplifying doses was shown to have some benefit on morbidity and patient satisfaction. Interventions delivered by pharmacists and nurses showed a better result in improving adherence and outcomes than interventions delivered by general practitioners.
Some interventions were found to have positive effect on adherence and outcomes, but no single strategy showed improvement in all settings. For future research patients should be screened for non-adherence to reveal both if they are non-adherent and type of non-adherence, as well as bigger sample sizes and longer duration of follow-up.
提供关于医疗保健机构提供的药物依从性干预措施对患者临床、经济和人文结局影响的证据。
检索Medline、Embase和CINAHL（2007 - 2017年）中的系统评价文献，使用评估系统评价的测量工具（AMSTAR）2和系统评价与Meta分析的首选报告项目问卷对质量进行验证，最后对纳入研究的结果进行提取、合并和制表。
从八项AMSTAR 2评分中等到高的系统评价中，提取了37项涉及28600名参与者的随机对照研究。患者教育和咨询对药物依从性有一些积极影响。患者教育对发病率、医疗保健效用和患者满意度也有一些积极影响。咨询对死亡率和医疗保健利用有一定益处。简化剂量对发病率和患者满意度有一定益处。药剂师和护士实施的干预措施在改善依从性和结局方面比全科医生实施的干预措施效果更好。
发现一些干预措施对依从性和结局有积极影响，但没有单一策略在所有情况下都显示出改善。对于未来的研究，应筛查患者的不依从情况，以揭示他们是否不依从以及不依从的类型，同时需要更大的样本量和更长的随访时间。
