背景:尽管以前的系统评价研究了2型糖尿病患者(PwT2D)的药物依从性干预措施,没有发现可持续改善药物依从性的干预措施.此外,干预描述的不一致和不良报告使人们理解,复制,和干预评估具有挑战性。
目的:我们旨在确定PwT2D中成功的药物依从性干预的行为改变技术(BCT)和特征。
方法:在Medline上进行了系统搜索,Embase,CINAHL,PsycINFO,Cochrane中央控制试验登记册,WebofScience,还有Scopus.如果研究是采用BCT可编码干预措施的随机对照试验,旨在影响18岁及以上PwT2D患者对抗糖尿病药物的依从性,并以药物依从性为结果。
结果:纳入了55项研究。成功的干预措施往往只针对药物依从性,让药剂师作为干预主义者,包含“可信来源”(BCT9.1),“关于如何执行行为的指令”(BCT4.1),“社会支持(实用)”(BCT3.2),“行动计划”(BCT1.4),和/或“有关健康后果的信息”(BCT5.1)。很少有干预措施描述其背景,使用理论,在干预结束后的随访期内检查依从性结果,或量身定制以解决药物依从性的特定障碍。
结论:我们确定了在成功的药物依从性干预措施中通常报道的特定BCT和特征,这可以促进未来干预措施的发展。我们的审查强调需要考虑和清楚地描述不同层面的背景,理论,保真度,在干预中剪裁。
药物治疗是糖尿病的主要治疗方法。然而,抗糖尿病口服药物和/或注射剂的使用可能是侵入性的,不方便,而且复杂,导致药物依从性差,这发生在大约50%的患者中。药物依从性是指一个人的服药行为与医疗保健提供者商定的建议相对应的程度,并且与次优的健康结果和增加的医疗保健支出有关。改善依从性的干预措施并没有一贯有效或得到很好的描述,这使得很难确定什么最有效。在这项研究中,我们的目的是确定行为改变技术(BCT)和2型糖尿病成人中成功的药物依从性干预的特征.BCT是干预措施中的活性成分,可调节药物依从性并具有标准化的定义。在系统地搜索了7个数据库后,我们分析了2018年1月-2022年3月发表的55项研究.我们发现,更有效的干预措施是那些只关注药物依从性的干预措施,参与药剂师,并包含特定的BCT,即“可信来源,“”关于如何执行行为的说明,“”社会支持(实用),“”行动计划,和/或“有关健康后果的信息”。这些特定的BCT和特征可以在未来的干预措施中考虑,以提高药物依从性。
BACKGROUND: Although previous systematic reviews have studied medication adherence interventions among people with Type 2 diabetes (PwT2D), no intervention has been found to improve medication adherence consistently. Furthermore, inconsistent and poor reporting of intervention description has made understanding, replication, and evaluation of intervention challenging.
OBJECTIVE: We aimed to identify the behavior change techniques (BCTs) and characteristics of successful medication adherence interventions among PwT2D.
METHODS: A systematic search was conducted on Medline, Embase, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus. Studies were included if they were randomized controlled trials with BCT-codable interventions designed to influence adherence to anti-diabetic medication for PwT2D aged 18 years old and above and have medication adherence measure as an outcome.
RESULTS: Fifty-five studies were included. Successful interventions tend to target medication adherence only, involve pharmacists as the interventionist, contain \"Credible source\" (BCT 9.1), \"Instruction on how to perform the behaviour\" (BCT 4.1), \"Social support (practical)\" (BCT 3.2), \"Action planning\" (BCT 1.4), and/ or \"Information about health consequences\" (BCT 5.1). Very few interventions described its context, used theory, examined adherence outcomes during the follow-up period after an intervention has ended, or were tailored to address specific barriers of medication adherence.
CONCLUSIONS: We identified specific BCTs and characteristics that are commonly reported in successful medication adherence interventions, which can facilitate the development of future interventions. Our review highlighted the need to consider and clearly describe different dimensions of context, theory, fidelity, and tailoring in an intervention.
Medication is the mainstay treatment for diabetes. However, the use of anti-diabetic oral medications and/or injections may be intrusive, inconvenient, and complicated, leading to poor medication adherence, which occurs in about 50% of patients. Medication adherence is the extent to which a person’s medication-taking behavior corresponds with agreed recommendations from a healthcare provider and is associated with suboptimal health outcomes and increased healthcare expenditure. Interventions to improve adherence have not been consistently effective or well described, which makes it difficult to ascertain what works best. In this study, we aimed to identify the behavior change techniques (BCTs) and characteristics of successful medication adherence interventions among adults with Type 2 diabetes. BCTs are active ingredients in an intervention that regulate medication adherence and have standardized definitions. After searching 7 databases systematically, we analyzed 55 studies published in January 2018—March 2022. We found that the more effective interventions were those which had a sole focus on medication adherence, involved pharmacists, and contained specific BCTs, namely “Credible source,” “Instruction on how to perform the behaviour,” “Social support (practical),” “Action planning,” and/or “information about health consequences.” These specific BCTs and characteristics can be considered in future interventions for improving medication adherence.