Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
BMJ Open. 2020 Jan 30;10(1):e032045. doi: 10.1136/bmjopen-2019-032045.
To estimate the efficacy of app-based interventions designed to support medication adherence and investigate which behaviour change techniques (BCTs) used by the apps are associated with efficacy.
Systematic review of randomised controlled trials (RCTs), with meta-analysis.
Medline/PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Embase and Web of Science were searched from 1990 to November 2018 for RCTs conducted in any healthcare setting.
Studies of participants of any age taking prescribed medication for any health condition and for any duration.
An app-based intervention delivered through a smartphone, tablet computer or personal digital assistant to help, support or advise about medication adherence.
One of (1) usual care, (2) a control app which did not use any BCTs to improve medication adherence or (3) a non-app-based comparator.
The primary outcome was the pooled effect size of changes in medication adherence. The secondary outcome was the association between BCTs used by the apps and the effect size.
The initial search identified 13 259 citations. After title and abstract screening, full-text articles of 83 studies were screened for eligibility. Nine RCTs with 1159 recruited participants were included. The mean age of participants was >50 years in all but one study. Health conditions of target populations included cardiovascular disease, depression, Parkinson's disease, psoriasis and multimorbidity. The meta-analysis indicated that patients who use mobile apps to support them in taking medications are more likely to self-report adherence to medications (OR 2.120, 95% CI 1.635 to 2.747, n=988) than those in the comparator groups. Meta-regression of the BCTs did not reveal any significant associations with effect size.
App-based medication adherence interventions may have a positive effect on patient adherence. Larger scale studies are required to further evaluate this effect, including long-term sustainability, and intervention and participant characteristics that are associated with efficacy and app usage.
PROSPERO Protocol Registration Number: CRD42017080150.
评估旨在支持药物依从性的基于应用程序的干预措施的疗效，并研究应用程序中使用的哪些行为改变技术（BCT）与疗效相关。
对随机对照试验（RCT）进行系统评价，并进行荟萃分析。
从 1990 年到 2018 年 11 月，在 Medline/PubMed、PsycINFO、护理学和联合健康文献累积索引、Embase 和 Web of Science 中搜索了在任何医疗保健环境中进行的 RCT。
任何年龄、服用任何处方药治疗任何疾病且持续时间不限的参与者。
通过智能手机、平板电脑或个人数字助理提供的基于应用程序的干预措施，以帮助、支持或提供关于药物依从性的建议。
（1）常规护理，（2）未使用任何 BCT 来提高药物依从性的对照应用程序，或（3）非基于应用程序的比较器。
主要结果是药物依从性变化的汇总效应大小。次要结果是应用程序中使用的 BCT 与效应大小之间的关联。
最初的搜索确定了 13259 个引用。经过标题和摘要筛选后，对 83 项研究的全文文章进行了资格筛选。纳入了 9 项 RCT，共招募了 1159 名参与者。除一项研究外，所有参与者的平均年龄均超过 50 岁。目标人群的健康状况包括心血管疾病、抑郁症、帕金森病、银屑病和多种疾病。荟萃分析表明，使用移动应用程序支持他们服药的患者比对照组更有可能自我报告药物依从性（OR 2.120，95%CI 1.635 至 2.747，n=988）。对 BCT 进行元回归未发现任何与效应大小相关的显著关联。
基于应用程序的药物依从性干预措施可能对患者的依从性产生积极影响。需要更大规模的研究来进一步评估这种效果，包括长期可持续性，以及与疗效和应用程序使用相关的干预措施和参与者特征。
PROSPERO 协议注册号：CRD42017080150。
