Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Room 0.038, 6200, Maastricht, MD, Netherlands.
Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Center, Nijmegen, Netherlands.
Osteoporos Int. 2020 Sep;31(9):1645-1669. doi: 10.1007/s00198-020-05378-0. Epub 2020 May 1.
An earlier systematic review on interventions to improve adherence and persistence was updated. Fifteen studies investigating the effectiveness of patient education, drug regimen, monitoring and supervision, and interdisciplinary collaboration as a single or multi-component intervention were appraised. Multicomponent interventions with active patient involvement were more effective.
This study was conducted to update a systematic literature review on interventions to improve adherence to anti-osteoporosis medications.
A systematic literature review was carried out in Medline (using PubMed), Embase (using Ovid), Cochrane Library, Current Controlled Trials, ClinicalTrials.gov , NHS Centre for Review and Dissemination, CINHAL, and PsycINFO to search for original studies that assessed interventions to improve adherence (comprising initiation, implementation, and discontinuation) and persistence to anti-osteoporosis medications among patients with osteoporosis, published between July 2012 and December 2018. Quality of included studies was assessed.
Of 585 studies initially identified, 15 studies fulfilled the inclusion criteria of which 12 were randomized controlled trials. Interventions were classified as (1) patient education (n = 9), (2) drug regimen (n = 3), (3) monitoring and supervision (n = 2), and (4) interdisciplinary collaboration (n = 1). In most subtypes of interventions, mixed results on adherence (and persistence) were found. Multicomponent interventions based on patient education and counseling were the most effective interventions when aiming to increase adherence and/or persistence to osteoporosis medications.
This updated review suggests that patient education, monitoring and supervision, change in drug regimen, and interdisciplinary collaboration have mixed results on medication adherence and persistence, with more positive effects for multicomponent interventions with active patient involvement. Compared with the previous review, a shift towards more patient involvement, counseling and shared decision-making, was seen, suggesting that individualized solutions, based on collaboration between the patient and the healthcare provider, are needed to improve adherence and persistence to osteoporosis medications.
更新关于改善抗骨质疏松症药物依从性和持久性的干预措施的系统评价。
在 Medline（使用 PubMed）、Embase（使用 Ovid）、Cochrane 图书馆、当前对照试验、ClinicalTrials.gov、NHS 中心进行系统文献检索，以评价提高骨质疏松症患者抗骨质疏松症药物依从性（包括起始、实施和停药）和持久性的干预措施。使用 CINHAL 和 PsycINFO 检索原始研究，评估干预措施的有效性。纳入研究的质量进行评估。
最初确定的 585 项研究中，有 15 项研究符合纳入标准，其中 12 项为随机对照试验。干预措施分为（1）患者教育（n=9）、（2）药物方案（n=3）、（3）监测和监督（n=2）和（4）跨学科合作（n=1）。在大多数干预措施类型中，对依从性（和持久性）的结果喜忧参半。基于患者教育和咨询的多组分干预措施是最有效的干预措施，旨在提高对骨质疏松症药物的依从性和/或持久性。
本更新综述表明，患者教育、监测和监督、药物方案改变以及跨学科合作对药物依从性和持久性的影响喜忧参半，而患者积极参与的多组分干预措施效果更为积极。与之前的综述相比，更多地关注患者参与、咨询和共同决策的趋势表明，需要基于患者和医疗保健提供者之间的合作，制定个体化的解决方案，以提高骨质疏松症药物的依从性和持久性。
