改善冠心病老年人服药依从性的教育计划：系统回顾与荟萃分析

IF 7.5 1区医学 Q1 NURSING

International Journal of Nursing Studies Pub Date : 2024-10-09 DOI:10.1016/j.ijnurstu.2024.104924

Mengqi Xu, Suzanne Hoi Shan Lo, Elaine Yi Ning Miu, Kai Chow Choi

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引用次数: 0

摘要

背景冠心病是导致全球死亡的主要原因。坚持服用冠心病药物是治疗冠心病的首要任务。患有冠心病的老年人的服药依从性并不理想。为改善患有冠心病的老年人的服药依从性，人们使用并推荐了教育计划。目的评价旨在改善冠心病老年人服药依从性的教育项目的效果。方法检索了从数据库开始到 2024 年 1 月的 12 个英文数据库和 5 个中文数据库。方法检索了12个英文数据库和5个中文数据库，检索时间为数据库建立后的2024年1月。纳入的随机对照试验研究了改善患有冠状动脉疾病（包括心肌梗死、稳定型或不稳定型心绞痛、接受经皮冠状动脉介入治疗或接受冠状动脉旁路移植术）的老年人（60岁或以上）服药依从性的教育项目的效果。纳入研究的质量由 Cochrane 偏倚风险工具 v2 进行评估。使用Review Manager 5.3的随机效应模型进行元分析。如果纳入研究的结果不适合或不可能进行荟萃分析，则进行叙述性综合。采用 "建议、评估、发展和评价分级 "方法评估证据的确定性。其中包括六项随机对照试验。结果显示，教育项目可显著改善干预后两到六个月内的服药依从性（标准化平均差（SMD）：1.13，95 % 置信区间（CI）：0.33 至 1.94，P = 0.006，中度证据确定性），但没有显著证据支持其对干预后一个月内的服药依从性的影响（SMD：2.18，95 % 置信区间（CI）：- 1.22 至 5.58，P = 0.21，低度证据确定性）。叙述性综述发现，教育项目有可能改善干预后六个月内的用药依从性、对冠心病及相关药物的了解以及药物管理能力。结论教育项目可显著改善冠心病老年人在干预后两到六个月内的用药依从性，并有可能改善干预后六个月内的用药依从性。干预后一个月内对服药依从性的影响尚无定论。设计具有理论框架和精炼内容的教育计划有助于满足他们复杂的健康需求。有必要对教育计划对患有冠心病的老年人坚持服药的影响进行更严格的评估：CRD42024472344；注册名称：改善冠心病老年人服药依从性的教育计划：系统综述）。

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Educational programmes for improving medication adherence among older adults with coronary artery disease: A systematic review and meta-analysis

Background

Coronary artery disease is the leading cause of death worldwide. Adhering to coronary artery disease medications is the priority of its treatment. Medication adherence is suboptimal among older adults with coronary artery disease. Educational programmes are used and recommended in improving medication adherence among older adults with coronary artery disease. The evidence about the effects of educational programmes on medication adherence among older adults with coronary artery disease is, however, limited.

Aim

To evaluate the effects of educational programmes designed for improving medication adherence among older adults with coronary artery disease.

Methods

12 English databases and five Chinese databases were searched from database inception to January 2024. Randomised controlled trials examining the effects of educational programmes for improving medication adherence among older adults (aged 60 years old or above) with coronary artery disease (including myocardial infarction, stable or unstable angina, undergoing percutaneous coronary intervention, or undergoing coronary artery bypass grafting) were included. The quality of the included studies was assessed by the Cochrane Risk of Bias Tool v2. Meta-analysis was conducted using random-effect models with Review Manager 5.3. Narrative synthesis was conducted if the results of the included studies were not appropriate or possible for meta-analysis. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to assess the certainty of evidence.

Results

5607 records were retrieved, and 5600 records were excluded. Six randomised controlled trials were included. The results showed that educational programmes could significantly improve medication adherence at two to six months post-intervention (standardised mean difference (SMD): 1.13, 95 % confidence interval (CI): 0.33 to 1.94, P = 0.006, Moderate certainty of evidence), but there was no significant evidence to support their effect on medication adherence within one-month post-intervention (SMD: 2.18, 95 % CI: − 1.22, 5.58, P = 0.21, Low certainty of evidence). Narrative synthesis found that the educational programmes potentially improved medication adherence over six months post-intervention, understanding of coronary artery disease and related medications, and medication management capacity.

Conclusions

Educational programmes could significantly improve medication adherence among older adults with coronary artery disease at two to six months post-intervention, and potentially improve medication adherence over six months post-intervention. The effect on medication adherence within one-month post-intervention was inconclusive. Designing the educational programmes with theoretical frameworks and refined components helps address their complex health needs. More rigorous evaluation of the effects of educational programmes on medication adherence of the older adults with coronary artery disease is warranted.

Registration

PROSPERO (Registration Number: CRD42024472344; Registration name: Educational programmes for improving medication adherence among older adults with coronary artery disease: A systematic review).

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来源期刊

International Journal of Nursing Studies 医学-护理

CiteScore

15.00

自引率

2.50%

发文量

181

审稿时长

21 days

期刊介绍： The International Journal of Nursing Studies (IJNS) is a highly respected journal that has been publishing original peer-reviewed articles since 1963. It provides a forum for original research and scholarship about health care delivery, organisation, management, workforce, policy, and research methods relevant to nursing, midwifery, and other health related professions. The journal aims to support evidence informed policy and practice by publishing research, systematic and other scholarly reviews, critical discussion, and commentary of the highest standard. The IJNS is indexed in major databases including PubMed, Medline, Thomson Reuters - Science Citation Index, Scopus, Thomson Reuters - Social Science Citation Index, CINAHL, and the BNI (British Nursing Index).