University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, United Kingdom.
University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, United Kingdom.
Res Social Adm Pharm. 2022 Dec;18(12):4017-4027. doi: 10.1016/j.sapharm.2022.07.042. Epub 2022 Aug 2.
The growing prevalence of mental health disorders in children and adolescents coupled with poor medication adherence in the paediatric population is a major problem within healthcare systems affecting patient outcomes. Digital health interventions (DHIs) are primed to optimise medication adherence given the expansion of digital health markets and the increased usage of digital technologies by children and adolescents.
This rapid systematic review evaluates the impact of DHIs on optimising medication adherence amongst children and adolescents with mental health disorders compared to treatment as usual (TAU).
A rapid systematic search in electronic databases CINAHL Plus, Cochrane Library, MEDLINE, PubMed, and Scopus was conducted. The scope of the rapid systematic search included randomised controlled trials and quasi-experimental studies (non-randomised controlled trials) evaluating DHIs optimising medication adherence in children and adolescents with attention deficit hyperactivity disorder (ADHD), depression and/or anxiety. Meta-analyses were conducted based on estimating pooled odds ratio (OR) and mean difference (MD) with 95% confidence interval using a random-effects model. Thematic analysis identified key avenues DHIs offer to optimise medication adherence.
Four studies were found, with 502 participants included in the meta-analysis. An improvement in medication adherence was observed following DHIs for studies measuring dichotomous and continuous outcomes. However, the effect was not significant for the former. DHIs were shown to help bridge the gaps between patients and healthcare professionals, allowing for more frequent monitoring, communication, and assessments.
Medication adherence amongst children and adolescents with acute or chronic ADHD, anxiety or depression may be positively impacted by DHIs, but better-powered studies with a lower risk of bias are necessary. The evidence currently remains inconclusive on DHIs improving medication adherence in children and adolescents.
儿童和青少年心理健康障碍的患病率不断上升，加之儿科人群药物依从性差，这是医疗系统中一个主要问题，影响患者的治疗效果。鉴于数字健康市场的扩张以及儿童和青少年对数字技术的使用增加，数字健康干预措施（DHIs）有望优化药物依从性。
本快速系统评价评估了 DHI 与常规治疗（TAU）相比，对优化患有心理健康障碍的儿童和青少年药物依从性的影响。
在 CINAHL Plus、Cochrane 图书馆、MEDLINE、PubMed 和 Scopus 电子数据库中进行了快速系统检索。快速系统检索的范围包括随机对照试验和准实验研究（非随机对照试验），评估 DHI 对优化患有注意力缺陷多动障碍（ADHD）、抑郁和/或焦虑的儿童和青少年药物依从性的影响。采用随机效应模型，根据估计的合并比值比（OR）和均数差（MD）及其 95%置信区间进行荟萃分析。主题分析确定了 DHI 优化药物依从性的主要途径。
共发现 4 项研究，其中 502 名参与者纳入荟萃分析。对于测量二分类和连续结局的研究，使用 DHI 后药物依从性得到改善。然而，前者的效果不显著。DHI 被证明有助于弥合患者和医疗保健专业人员之间的差距，从而可以更频繁地进行监测、沟通和评估。
急性或慢性 ADHD、焦虑或抑郁的儿童和青少年的药物依从性可能会受到 DHI 的积极影响，但需要进行更好的研究，以降低偏倚风险。目前关于 DHI 提高儿童和青少年药物依从性的证据尚无定论。
