Intervention Review

Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings

  1. Knut Schroeder1,*,
  2. Tom Fahey2,
  3. Shah Ebrahim3

Editorial Group: Cochrane Hypertension Group

Published Online: 19 JUL 2004

Assessed as up-to-date: 25 FEB 2004

DOI: 10.1002/14651858.CD004804

How to Cite

Schroeder K, Fahey T, Ebrahim S. Interventions for improving adherence to treatment in patients with high blood pressure in ambulatory settings. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD004804. DOI: 10.1002/14651858.CD004804.

Author Information

  1. 1

    Department of Community Based Medicine, Academic Unit of Primary Health Care, Cotham Hill, Bristol, UK

  2. 2

    Royal College of Surgeons in Ireland Medical School, Department of Family Medicine and General Practice, Dublin, Ireland

  3. 3

    London School of Hygiene & Tropical Medicine, Department of Epidemiology & Population Health, London, UK

*Knut Schroeder, Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Cotham House, Cotham Hill, Bristol, BS6 6JL, UK. k.schroeder@bristol.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 JUL 2004

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

Background

Lack of adherence to blood pressure lowering medication is a major reason for poor control of hypertension worldwide. Interventions to improve adherence to antihypertensive medication have been evaluated in randomised trials but it is unclear which interventions are effective.

Objectives

To determine the effectiveness of interventions aiming to increase adherence to blood pressure lowering medication in adults with high blood pressure

Search methods

All-language search of all articles (any year) in the Cochrane Controlled Trials Register (CCTR), MEDLINE, EMBASE, and CINAHL in April 2002.

Selection criteria

RCTs of interventions to increase adherence to blood pressure lowering medication in adults with essential hypertension in primary care, with adherence to medication and blood pressure control as outcomes

Data collection and analysis

Two authors extracted data independently and in duplicate and assessed each study according to the criteria outlined by the Cochrane Collaboration Handbook.

Main results

We included 38 studies testing 58 different interventions and containing data on 15519 patients. The studies were conducted in nine countries between 1975 and 2000. The duration of follow-up ranged from two to 60 months. Due to heterogeneity between studies in terms of interventions and the methods used to measure adherence, we did not pool the results. Simplifying dosing regimens increased adherence in seven out of nine studies, with a relative increase in adherence of 8 per cent to 19.6 per cent. Motivational strategies were successful in 10 out of 24 studies with generally small increases in adherence up to a maximum of 23 per cent. Complex interventions involving more than one technique increased adherence in eight out of 18 studies, ranging from 5 per cent to a maximum of 41 per cent. Patient education alone seemed largely unsuccessful.

Authors' conclusions

Reducing the number of daily doses appears to be effective in increasing adherence to blood pressure lowering medication and should be tried as a first line strategy, although there is less evidence of an effect on blood pressure reduction. Some motivational strategies and complex interventions appear promising, but we need more evidence on their effect through carefully designed RCTs.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

What interventions improve adherence to treatment in patients with high blood pressure in ambulatory settings

High blood pressure is a major risk factor for heart attack and stroke, and drug treatment of high blood pressure can substantially reduce this risk. However, the control of high blood pressure in the community is far from optimal. One of the major reasons for this is that patients with high blood pressure often fail to take their medication as prescribed. A number of interventions have been tested that aim to help patients take their medication but it is still uncertain how effective they are.

This review evaluates the effectiveness of interventions aiming to help patients with taking blood pressure lowering medication. We included studies in adult patients with a diagnosis of high blood pressure in a community setting and assessed interventions that aimed to increase adherence to blood pressure lowering medication. The outcomes assessed were adherence to medication and blood pressure changes.

For many interventions it is difficult to draw any real conclusions due to weaknesses of the included studies. However, reducing the number of daily doses appears to be effective in increasing adherence to blood pressure lowering medication and should be tried as a first line strategy although there is little evidence of an effect on blood pressure reduction. Some motivational strategies and complex interventions appear promising but we need more evidence on their effect through carefully designed randomised controlled trials to confirm these findings.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

改善高血壓門診病人服藥順從性的介入性方法

研究背景

降血壓藥物的缺乏服藥順從性是一個全世界高血壓控制不良的重要原因。 介入性方式對於改善服用降血壓藥物的堅持已經隨機試驗中被評估,但目前還不清楚哪些介入性方法是有效的。

研究目的

決定介入性方法的有效性,目標是對於血壓高的成人增加降血壓藥物的服藥順從性。

检索方法

於2002年4月搜尋Cochrane Controlled Trials Register (CCTR)、 MEDLINE、 EMBASE、與CINAHL所有語言的所有文章(年分不拘)。

纳入标准

隨機控制試驗的介入性方法,在第一線照護中,以增加降血壓藥物的服藥順從性在患有本態性高血壓的成人服用,和血壓控制的成果

数据收集与分析

兩位作者獨立地、同時 (一式兩份)提取數據,並依照考科藍協作組織手冊的準則評估每個研究。

主要结果

我們包括38研究,58種不同的介入性方法方式和15519位病人的數據。 研究於1975∼2000年間在9個國家進行。後續追蹤時間不等,由2個月至60個月。 由於介入與評估持續性的方法具有異質性,因此我們並沒有匯總結果。 9個實驗當中有7個顯示,簡化用藥方式可以增加了用藥順服性,增加約8%至19.6 %持續性。24個研究當中有10個研究成功採用動機策略(Motivational strategies),從輕微到大幅(23%)增加用藥順服性。 18個研究採用超過一種技術的綜合性介入,其中8個增加了用藥順服性,從5%∼至大幅增加41%。而教育方案是最不成功的一種。

作者结论

雖然少有的證據顯示,可以有效的降低血壓,但減少每日服用次數似乎可有效地提高降血壓藥物的服藥順從性,而這也應該是作為第一線的策略。一些激勵策略和綜合介入性方法似乎效果可期,但我們需要更多的證據顯示他們是有效的透過精心設計的隨機對照試驗。

 

概要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. 概要

改善高血壓門診病人服藥順從性的介入性方法

血壓高是心臟病發作和中風重大的危險因素,藥物治療血壓高可以大大減少這方面的風險。然而,社區中之高血壓控制總是和理想相去甚遠。其中一個重要的原因,這是因為患有高血壓的病患往往在藥物控制方面失敗,沒有按照規定進行。一些介入性方法性措施已經在測試,目的是幫助病人服藥,但仍是不清楚它們成效如何。 這篇回顧性文章評估介入性方法措施的有效性,以幫助患有高血壓的患者,降低了藥物治療。我們包含了那些被診斷為血壓高的成人患者的研究,在一個社區環境,和評估介入性措施的效果,目的在增加堅持血壓降低的藥物的服藥堅持度。結果評估的著重在服藥和血壓的改變。對於許多介入性方法是很難得出任何結論,由於研究本身的弱點許多介入性方法是很難得出任何結論的。雖然少有證據證明可以有效的減少血壓高的問題,不過每日劑量的減少似乎可有效提高降血壓藥物順服性,並且應該作為第一線的策略。一些激勵策略和複雜的介入性方法似乎效果可期,但我們需要更多的證據顯示他們是有效的透過精心設計的隨機對照試驗,以確認這些研究結果。

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