Department of Pharmacology, St. John's Medical College, Bengaluru, India.
Division of Geriatrics, Department of Medicine, St. John's Medical College, Bengaluru, India.
Geriatr Gerontol Int. 2020 Nov;20(11):1079-1084. doi: 10.1111/ggi.14032. Epub 2020 Sep 8.
Adherence to medication is important in older patients with non-communicable diseases, and there is a need to investigate various interventions to enhance adherence in our Indian setting. This pilot randomized controlled trial aimed at testing the effectiveness of systematic education and behavioral intervention in enhancing medication adherence among older adults.
It was a single center, open label, parallel arm, randomized controlled trial carried out among older (age >60 years) inpatients of general medicine wards diagnosed with select non-communicable diseases, such as diabetes, hypertension, dyslipidemia and coronary artery disease. Participants were randomized either to receive the usual standard of care or the intervention that comprises of systematic education, patient diary to mark daily medicine intake and periodic telephone reminders. Barriers to medication adherence were identified and interventions were tailored according to the identified barriers over a 6-month follow-up period. The primary end-points were change in the reported pill count (RPC) within groups and between groups at the third and sixth month.
The RPC in control and intervention arms at the thrid month were 78.20% and 91.88% (P = 0.007), whereas at 6 months they were 68.64% and 83.08% (P = 0.003), respectively. Similarly, change in RPC in intervention arm between baseline and the third month (mean difference 24.08%, P = 0.001), and between baseline and the sixth month (mean difference 15.280%, P = 0.006) were statistically significant. However, the RPC between the third and sixth month showed a significant decline (mean difference 8.8%, P = 0.016).
In this pilot study, we prove that behavioral interventions have improved medication adherence among older adults, and it is feasible to carry out such studies among older adults in India. Geriatr Gerontol Int 2020; 20: 1079-1084.
在患有非传染性疾病的老年患者中，坚持用药非常重要，因此需要研究各种干预措施以提高我们印度国内患者的用药依从性。本研究旨在检验系统教育和行为干预对提高老年患者用药依从性的有效性。
这是一项在印度进行的单中心、开放标签、平行臂、随机对照试验，纳入了年龄＞60 岁的老年（＞60 岁）综合内科住院患者，他们被诊断患有特定的非传染性疾病，如糖尿病、高血压、血脂异常和冠心病。参与者被随机分为接受常规标准护理或干预组，干预组包括系统教育、患者日记以标记每日药物摄入量和定期电话提醒。在 6 个月的随访期间，根据识别出的用药障碍来确定干预措施并进行调整。主要终点是组内和组间第 3 个月和第 6 个月报告的药物计数（RPC）变化。
对照组和干预组在第 3 个月的 RPC 分别为 78.20%和 91.88%（P = 0.007），而在第 6 个月分别为 68.64%和 83.08%（P = 0.003）。同样，干预组中 RPC 从基线到第 3 个月的变化（平均差异 24.08%，P = 0.001）和从基线到第 6 个月的变化（平均差异 15.280%，P = 0.006）均具有统计学意义。然而，第 3 个月和第 6 个月之间的 RPC 显著下降（平均差异 8.8%，P = 0.016）。
在这项试点研究中，我们证明行为干预可以提高老年患者的用药依从性，并且在印度开展此类研究是可行的。老年医学与老年病学杂志 2020;20:1079-1084。
