Health Research Institute, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia.
Centre for Applied Health Economics; Centre for Applied Health Economics, School of Medicine & Menzies Health Institute, Griffith University, Gold Coast, Australia.
J Nephrol. 2021 Aug;34(4):1091-1125. doi: 10.1007/s40620-020-00895-x. Epub 2021 Feb 9.
Medication non-adherence is a well-recognised issue in chronic diseases but data in patients with chronic kidney disease (CKD) not receiving kidney replacement therapy (KRT) remains limited. This review summarised the prevalence of medication non-adherence and assessed determinants and outcomes associated with it in adults with CKD, not on KRT.
We searched PubMed, Embase, PsychInfo, Web of Science, and Cochrane (CENTRAL) for studies published until January 2020. Pooled prevalence of medication non-adherence was reported. Determinants of adherence-identified from quantitative and qualitative studies-were mapped into the theoretical domains framework and interventions proposed using the behavioural change wheel.
Twenty-seven studies (22 quantitative and 5 qualitative) were included. The pooled prevalence of medication non-adherence was 39% (95% CI 30-48%). Nine studies reported association between non-adherence and outcomes, including blood pressure, disease progression, adverse events, and mortality. Modifiable determinants of non-adherence were mapped into 11 of the 14 Theoretical Domains Framework-of which, six appeared most relevant. Non-adherence decisions were usually due to lack of knowledge on CKD, comorbidities, and medications; polypharmacy and occurrence of medication side effects; changes in established routines such as frequent medication changes; higher medication cost, poor accessibility to medications, services and facilities; inadequate patient-healthcare professional communication; and forgetfulness. Using the behavioural change wheel, we identified several areas where interventions can be directed to improve medication adherence.
Medication non-adherence is common in adults with CKD, not on KRT and may lead to poor outcomes. Evidence synthesis using mixed study designs was crucial in identifying determinants of non-adherence, drawing on a parsimonious approach from behaviour science.
CRD42020149983.
药物不依从是慢性疾病中一个众所周知的问题，但在未接受肾脏替代治疗（KRT）的慢性肾脏病（CKD）患者中，相关数据仍然有限。本综述总结了CKD 患者（未接受 KRT）药物不依从的流行率，并评估了与药物不依从相关的决定因素和结局。
我们检索了 PubMed、Embase、PsychInfo、Web of Science 和 Cochrane（CENTRAL）数据库，检索截至 2020 年 1 月发表的研究。报告了药物不依从的总体流行率。从定量和定性研究中确定的依从性决定因素被映射到理论领域框架中，并使用行为改变轮提出干预措施。
共纳入 27 项研究（22 项定量研究和 5 项定性研究）。药物不依从的总体流行率为 39%（95%CI 30-48%）。有 9 项研究报告了不依从与结局之间的关联，包括血压、疾病进展、不良事件和死亡率。可改变的不依从决定因素被映射到 14 个理论领域框架中的 11 个，其中 6 个被认为是最相关的。不依从决定通常是由于缺乏对 CKD、合并症和药物的了解、药物的多药治疗和副作用的发生、既定常规的改变，如频繁改变药物；药物费用较高、药物获取、服务和设施不足；医患沟通不足；以及健忘。使用行为改变轮，我们确定了几个可以改善药物依从性的干预领域。
在未接受 KRT 的 CKD 成人中，药物不依从很常见，可能导致不良结局。使用混合研究设计进行证据综合对于确定不依从的决定因素至关重要，从行为科学中采用了一种简洁的方法。
PROSPERO 注册号：CRD42020149983。
