Holbrook Anne M, Wang Mei, Lee Munil, Chen Zhiyuan, Garcia Michael, Nguyen Laura, Ford Angela, Manji Selina, Law Michael R
Division of Clinical Pharmacology & Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Syst Rev. 2021 Jan 6;10(1):11. doi: 10.1186/s13643-020-01558-5.
Cost-related nonadherence to medications (CRNA) is common in many countries and thought to be associated with adverse outcomes. The characteristics of CRNA in Canada, with its patchwork coverage of increasingly expensive medications, are unclear.
Our objective in this systematic review was to summarize the literature evaluating CRNA in Canada in three domains: prevalence, predictors, and effect on clinical outcomes.
We searched MEDLINE, Embase, Google Scholar, and the Cochrane Library from 1992 to December 2019 using search terms covering medication adherence, costs, and Canada. Eligible studies, without restriction on design, had to have original data on at least one of the three domains specifically for Canadian participants. Articles were identified and reviewed in duplicate. Risk of bias was assessed using design-specific tools.
Twenty-six studies of varying quality (n = 483,065 Canadians) were eligible for inclusion. Sixteen studies reported on the overall prevalence of CRNA, with population-based estimates ranging from 5.1 to 10.2%. Factors predicting CRNA included high out-of-pocket spending, low income or financial flexibility, lack of drug insurance, younger age, and poorer health. A single randomized trial of free essential medications with free delivery in Ontario improved adherence but did not find any change in clinical outcomes at 1 year.
CRNA affects many Canadians. The estimated percentage depends on the sampling frame, the main predictors tend to be financial, and its association with clinical outcomes in Canada remains unproven.
与费用相关的药物治疗不依从（CRNA）在许多国家都很常见，并且被认为与不良后果相关。在加拿大，随着对日益昂贵药物的拼凑式覆盖，CRNA的特征尚不清楚。
我们进行这项系统评价的目的是总结在三个领域评估加拿大CRNA的文献：患病率、预测因素以及对临床结局的影响。
我们使用涵盖药物依从性、费用和加拿大的检索词，检索了1992年至2019年12月期间的MEDLINE、Embase、谷歌学术和考克兰图书馆。符合条件的研究不限设计类型，但必须有专门针对加拿大参与者的这三个领域中至少一个领域的原始数据。文章通过双人识别和审查。使用特定设计工具评估偏倚风险。
26项质量各异的研究（n = 483,065名加拿大人）符合纳入条件。16项研究报告了CRNA的总体患病率，基于人群的估计范围为5.1%至10.2%。预测CRNA的因素包括高额自付费用、低收入或财务灵活性差、缺乏药物保险、年龄较小以及健康状况较差。安大略省一项关于免费提供基本药物并免费配送的随机试验提高了依从性，但在1年时未发现临床结局有任何变化。
CRNA影响着许多加拿大人。估计百分比取决于抽样框架，主要预测因素往往是财务方面的，并且其与加拿大临床结局的关联仍未得到证实。
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