Duke-NUS Medical School, Singapore, Singapore.
Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
J Gen Intern Med. 2021 Sep;36(9):2784-2795. doi: 10.1007/s11606-021-06648-1. Epub 2021 Mar 3.
OBJECTIVE: To summarize the available conceptual models for factors contributing to medication adherence based on the World Health Organization (WHO)'s five dimensions of medication adherence via a systematic review, identify the patient groups described in available conceptual models, and present an adaptable conceptual model that describes the factors contributing to medication adherence in the identified patient groups. METHODS: We searched PubMed®, Embase®, CINAHL®, and PsycINFO® for English language articles published from inception until 31 March 2020. Full-text original publications in English that presented theoretical or conceptual models for factors contributing to medication adherence were included. Studies that presented statistical models were excluded. Two authors independently extracted the data. RESULTS: We identified 102 conceptual models, and classified the factors contributing to medication adherence using the WHO's five dimensions of medication adherence, namely patient-related, medication-related, condition-related, healthcare system/healthcare provider-related, and socioeconomic factors. Eight patient groups were identified based on age and disease condition. The most universally addressed factors were patient-related factors. Medication-related, condition-related, healthcare system-related, and socioeconomic factors were represented to various extents depending on the patient group. By systematically examining how the WHO's five dimensions of medication adherence were applied differently across the eight different patient groups, we present a conceptual model that can be adapted to summarize the common factors contributing to medication adherence in different patient groups. CONCLUSION: Our conceptual models can be utilized as a guide for clinicians and researchers in identifying the facilitators and barriers to medication adherence and developing future interventions to improve medication adherence. PROTOCOL REGISTRATION: PROSPERO Identifier: CRD42020181316.
目的:通过系统评价,总结世界卫生组织(WHO)五个维度的药物依从性概念模型中与药物依从性相关的因素,确定现有概念模型中描述的患者群体,并提出一个适应性强的概念模型,描述所确定的患者群体中与药物依从性相关的因素。
方法:我们在 PubMed®、Embase®、CINAHL®和 PsycINFO® 中检索了从创建到 2020 年 3 月 31 日发表的英文文章。纳入了提出与药物依从性相关因素的理论或概念模型的英文全文原始出版物。排除了提出统计模型的研究。两位作者独立提取数据。
结果:我们确定了 102 个概念模型,并使用 WHO 的五个维度的药物依从性对药物依从性的影响因素进行分类,即患者相关、药物相关、病情相关、医疗保健系统/医疗保健提供者相关和社会经济因素。根据年龄和疾病状况确定了 8 个患者群体。最普遍涉及的因素是患者相关因素。药物相关、病情相关、医疗保健系统相关和社会经济因素根据患者群体的不同,在不同程度上得到了体现。通过系统地检查 WHO 的五个维度的药物依从性在八个不同患者群体中的应用方式的不同,我们提出了一个概念模型,可以用来总结不同患者群体中与药物依从性相关的共同因素。
结论:我们的概念模型可以作为临床医生和研究人员的指南,用于确定药物依从性的促进因素和障碍,并制定改善药物依从性的未来干预措施。
方案注册:PROSPERO 标识符:CRD42020181316。
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