摘要
目的 系统评价慢性病共病患者服药依从性的影响因素,为提高服药依从性提供循证依据.方法 检索中国知网、万方数据知识服务平台、维普中文科技期刊数据库、中国生物医学数据库、PubMed、Web of Science、Cochrane Library和Embase数据库建库至2024年1月20日发表的有关慢性病共病患者服药依从性影响因素的文献.2名研究人员独立进行文献筛选、资料提取和质量评价后,采用RevMan 5.4和Stata 16.0软件进行Meta分析;逐一剔除文献进行敏感性分析;采用Egger检验评价发表偏倚.结果 初期检索相关文献7 365篇,最终纳入35篇,总样本量约15万人,其中横断面研究30篇,队列研究5篇;高质量文献11篇,中等质量文献24篇.Meta分析结果显示,受教育程度较低(OR=2.148,95%CI:1.711～2.696)、经济收入较低(OR=1.897,95%CI:1.589～2.264)、男性(OR=0.877,95%CI:0.782～0.985)、独居(OR=2.833,95%CI:1.756～4.569)和未婚(OR=2.784,95%CI:1.251～6.196)等人口学因素,多药治疗(OR=1.794,95%CI:1.190～2.706)、潜在不当用药(OR=2.988,95%CI:1.527～5.847)、日服药频率低(OR=0.533,95%CI:0.376～0.754)和出现药物不良反应(OR=3.319,95%CI:1.967～5.602)等药物治疗因素,病程长(OR=2.118,95%CI:1.643～2.730)、共病数量多(OR=1.667,95%CI:1.143～2.431)和认知功能障碍(OR=2.007,95%CI:1.401～2.874)等疾病因素,以及服药信念差(OR=1.251,95%CI:1.011～1.547)、自评健康状况不佳(OR=1.990,95%CI:1.571～2.522)和获医护人员指导(OR=0.151,95%CI:0.062～0.368)等心理社会因素是慢性病共病患者服药依从性的影响因素.结论 慢性病共病患者服药依从性的影响因素包括人口学因素、药物治疗因素、疾病因素和心理社会因素4个方面,主要为独居、药物不良反应、病程、共病数量和服药信念等因素.
Abstract
Objective To systematically evaluate the influencing factors for medication compliance in patients with co-morbidities of chronic diseases,so as to provide the evidence for improving medication compliance.Methods Literature on influencing factors for medication compliance in patients with comorbidities of chronic diseases were retrived from CNKI,Wanfang Data,VIP,SinoMed,PubMed,Web of Science,Cochrane Library and Embase from inception to January 20,2024.After independent literature screening,data extraction,and quality assessment by two researchers,a meta-anal-ysis was performed using RevMan 5.4 and Stata 16.0 softwares.Literature were excluded one by one for sensitivity anal-ysis.Publication bias was assessed using Egger's test.Results Initially,7 365 relevant articles were retrieved,and 35 of them were finally included,with a total sample size of about 150 000 individuals.There were 30 cross-sectional studies and 5 cohort studies;and 11 high-quality studies and 24 medium-quality studies.The meta-analysis showed that the demographic factors of lower level of education(OR=2.148,95%CI:1.711-2.696),lower economic income(OR=1.897,95%CI:1.589-2.264),male(OR=0.877,95%CI:0.782-0.985),living alone(OR=2.833,95%CI:1.756-4.569)and unmarried(OR=2.784,95%CI:1.251-6.196);the medication treatment factors of polypharmacy(OR=1.794,95%CI:1.190-2.706),potentially inappropriate medication(OR=2.988,95%CI:1.527-5.847),low frequency of daily medication(OR=0.533,95%CI:0.376-0.754)and adverse drug reactions(OR=3.319,95%CI:1.967-5.602);the disease factors of long course of disease(OR=2.118,95%CI:1.643-2.730),more comorbidities(OR=1.667,95%CI:1.143-2.431)and cognitive impairment(OR=2.007,95%CI:1.401-2.874);and the psychosocial factors of poor belief in taking medication(OR=1.251,95%CI:1.011-1.547),poor self-rated health(OR=1.990,95%CI:1.571-2.522)and being guided by healthcare professionals(OR=0.151,95%CI:0.062-0.368)were the influencing factors for medication compliance in patients with chronic comorbidities.Conclusion The medication compliance in patients with comorbidities of chronic diseases is asso-ciated with demographic factors,pharmacological factors,disease factors and psychosocial factors,mainly including living alone,adverse drug reactions,course of disease,number of comorbidities and medication beliefs.
基金项目
山西省社会科学界联合会2023至2024年度重点课题项目(SSKLZDKT2023117)
山西省研究生实践创新项目(2023SJ272)
山西中医药大学2023年度科技创新能力培育计划软科学研究专项资助项目(2023PY-RKX-03)
2023年山西中医药大学研究生教育创新项目(2023CX053)
2022年山西中医药大学研究生优硕创新项目(2022YS023)
维普
万方数据