中国高血压患者用药依从性的meta分析

Meta-analysis of Medication Adherence Among Chinese Patients with Hypertension

关键词:  药物依从性  高血压  Morisky用药依从性量表  meta分析

Key words:  medication adherence  hypertension  Morisky Medication Adherence scale  meta-analysis

摘要:

目的 探讨中国高血压患者用药依从性与不同年龄组、性别、测量工具、经济水平和文化程度之间的差异。方法 使用3个英文数据库（PubMed，Web of Science和Embase）和3个中文数据库（知网、万方和维普）检索在2010年1月—2018年9月发表的相关文献。随机效应模型用于计算效应量大小和95%CI，另外进行了亚组分析，以确定这些比较中潜在的异质性来源。结果 最终27篇文献被纳入本次研究，包括来自14个省、3个直辖市和1个特别行政区的20 140名参与者。分析结果显示，我国的高血压患者用药依从率为42.0%（95%CI：36.0%~48.0%）。通过亚组分析，8项Morisky用药依从性量表作为测量工具的依从率为49.4%（95%CI：38.9%~59.9%）；而4项Morisky用药依从量表为37.5%（95%CI：31.1%~44.0%）。具有小学或以下，中学，大专或以上学历的患者的用药依从率分别为49.5%，49.6%和53.6%。男性患者（47.5%）的药物依从率略低于女性（48.4%）。≥60岁的患者（51.0%）的用药依从率高于＜60岁的患者（46.9%）。在发达地区的参与者的用药依从率（48.3%）比不发达地区（37.5%）更高。结论 中国高血压患者用药依从率相对较低，不同的测量工具可能会影响患者的用药依从率，学历、性别、经济水平是高血压患者用药依从性的影响因素。目前急需有效的干预措施来解决和缓解这一问题。

Abstract:

OBJECTIVE To explore differences in medication adherence among Chinese patients with hypertension with different age groups, gender, measuring tools, economic level and educational levels. METHODS Three English databases (PubMed, Web of Science and Embase) and three Chinese databases (CNKI, WanFang and CQVIP) were used to retrieve the relevant literature published from January 2010 to September 2018. Random effect models were applied to calculate pooled effect size with 95% CI. Subgroup analysis was applied to identify potential sources of heterogeneity among these comparisons. RESULTS Final 27 papers were adopted including 20 140 participants from 14 provinces, 3 municipalities and 1 region. Results showed that the adherence rate of hypertension patients in China was 42.0%(95%CI:36.0%-48.0%). Subgroup analysis showed that the eight-item Morisky Medication Adherence scale value was 49.4%(95%CI:38.9%-59.9%). The four-item Morisky Medication Adherence Scale value was 37.5%(95%CI:31.1%-44.0%). Patients with educational levels of primary or below, secondary, and tertiary or above had adherence results of 49.5%, 49.6% and 53.6%, respectively. Male patients(47.5%) medication adherence was slightly lower than female(48.4%). The adherence rate of patients over 60 years of age(51.0%) was higher than that of patients under 60 years of age(46.9%). The medication adherence rate(48.3%) was higher than that(37.5%) in developed regions. CONCLUSION Medication adherence among Chinese patients with hypertension is relatively low. Different measuring tools may affect the results of medication adherence measurement. Education, gender and economic level are the influencing factors of medication adherence in patients with hypertension effective interventions are urgently needed to improve address and mitigate this problem.