Richard E Deichmann, Michael D Morledge, Robin Ulep, Johnathon P Shaffer, Philippa Davies, Mieke L van Driel
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引用次数: 0
Abstract
Background: Inadequate patient adherence to a medication regimen is a major factor in the lack of success in treating hyperlipidemia. Improved adherence rates may result in significantly improved cardiovascular outcomes in populations treated with lipid-lowering therapy. The purpose of this metaanalysis was to evaluate the effectiveness of interventions aimed at improving adherence to lipid-lowering drugs, focusing on measures of adherence and clinical outcomes.
Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature databases through January 14, 2015, and also used the results from previous Cochrane reviews of this title. Randomized controlled trials of adherence-enhancing interventions for lipid-lowering medication in adults in an ambulatory setting with measurable outcomes were evaluated with criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions.
Results: Twenty-seven studies randomly assigning 899,068 participants to a variety of interventions were analyzed. One group of interventions categorized as intensified patient care showed significant improvement in adherence rates when compared to usual care (odds ratio 1.93; 95% confidence interval [CI] 1.29-2.88). Additionally, after <6 months of follow-up, total cholesterol decreased by a mean of 17.15 mg/dL (95% CI 1.17-33.14), while after >6 months total cholesterol decreased by a mean of 17.57 mg/dL (95% CI 14.95-20.19).
Conclusion: Healthcare systems that can implement team-based intensified patient care interventions, such as electronic reminders, pharmacist-led interventions, and healthcare professional education of patients, may be successful in improving adherence rates to lipid-lowering medicines.
背景：患者对药物治疗方案的依从性不足是高脂血症治疗不成功的一个主要因素。提高患者的依从性可显著改善降脂治疗人群的心血管预后。本荟萃分析旨在评估旨在提高降脂药物依从性的干预措施的有效性，重点关注依从性和临床结果的测量：我们检索了截至 2015 年 1 月 14 日的 Cochrane Central Register of Controlled Trials、MEDLINE、EMBASE、PsycINFO 和 Cumulative Index to Nursing and Allied Health Literature 数据库，同时还使用了之前 Cochrane 就此标题进行的综述结果。根据《科克伦干预措施系统综述手册》中列出的标准，对门诊环境中成人降脂药物依从性增强干预措施的可测量结果进行了随机对照试验评估：对 27 项研究进行了分析，这些研究将 899,068 名参与者随机分配给各种干预措施。其中一组被归类为加强患者护理的干预措施与常规护理相比，在坚持率方面有显著改善（几率比 1.93；95% 置信区间 [CI] 1.29-2.88）。此外，6 个月后，总胆固醇平均下降了 17.57 mg/dL (95% CI 14.95-20.19)：结论：医疗保健系统如能实施以团队为基础的患者强化护理干预措施，如电子提醒、药剂师主导的干预措施以及对患者进行医疗保健专业教育，可能会成功提高降脂药物的依从率。
期刊介绍：
The Ochsner Journal is a quarterly publication designed to support Ochsner"s mission to improve the health of our community through a commitment to innovation in healthcare, medical research, and education. The Ochsner Journal provides an active dialogue on practice standards in today"s changing healthcare environment. Emphasis will be given to topics of great societal and medical significance.
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