School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Australia.
Transl Behav Med. 2020 Dec 31;10(6):1419-1435. doi: 10.1093/tbm/ibz125.
In 2008, Apple and Android launched their Application or "App" stores. Since then, there has been a growing interest in using mobile apps for improving medication adherence. However, research on the efficacy of apps, in terms of improved medication adherence and clinical outcome and/or patient-related outcome measures (PROMs) is scarce. The objective of this research was to systematically review the impact of apps on consumers' medication adherence and to determine the effect on clinical outcome and/or PROM(s). A systematic literature search was conducted to identify publications aimed at improving medication adherence published from January 2008 to April 2018. All studies were assessed for risk of bias using either the Risk Of Bias In Non-randomized Studies-of Interventions or the revised tool for Risk of Bias in randomized trials tool, depending on study design. Eleven randomized controlled trials (RCTs) and 10 non-RCTs were included. All 11 RCTs showed improvements in adherence; however, only seven reported statistically significant improvements in at least one adherence measure. Nine RCTs also demonstrated improvements in clinical outcome/PROM(s), of which five were statistically significant, whereas two RCTs did not report on clinical outcome/PROM(s). Only two studies using non-RCT study designs showed statistically significant improvements in all measures of adherence and clinical outcome/PROM(s). The risk of bias was moderate or serious for all included studies. Even though the use of an app may improve adherence, it is difficult to draw conclusions regarding the impact of apps on medication adherence due to the high degree of heterogeneity across studies, from the methodological design to the features of the app and the measure of adherence.
2008 年，苹果和安卓推出了他们的应用程序（App）商店。从那时起，人们越来越感兴趣地使用移动应用程序来提高药物依从性。然而，关于应用程序在改善药物依从性和临床结果和/或患者相关结果测量（PROMs）方面的功效的研究很少。本研究的目的是系统地回顾应用程序对消费者药物依从性的影响，并确定其对临床结果和/或 PROM 的影响。系统文献检索旨在识别 2008 年 1 月至 2018 年 4 月发表的旨在提高药物依从性的出版物。根据研究设计，使用干预措施的非随机研究的偏倚风险评估工具或修订后的随机试验偏倚风险评估工具评估所有研究的偏倚风险。纳入了 11 项随机对照试验（RCT）和 10 项非随机对照试验。所有 11 项 RCT 均显示出依从性的改善；然而，只有 7 项报告了至少一项依从性测量的统计学显著改善。9 项 RCT 还显示出临床结果/PROM 的改善，其中 5 项具有统计学意义，而 2 项 RCT 未报告临床结果/PROM。仅使用非 RCT 研究设计的两项研究显示在所有依从性和临床结果/PROM 测量方面均有统计学显著改善。所有纳入研究的偏倚风险为中度或严重。尽管使用应用程序可能会提高依从性，但由于研究之间存在高度异质性，从方法设计到应用程序的功能和依从性测量，很难得出关于应用程序对药物依从性影响的结论。
