中国药师干预对糖尿病患者用药依从性影响的系统评价

Evaluation of Effect of Pharmacist Intervention on Medication Compliance of Patients with Diabetes in China

目的:系统评价国内由药师开展的药学干预对糖尿病患者用药依从性和血糖控制的影响。方法:计算机检索Pubmed(1993-2013)、中国期刊全文数据库(CNKI,1993-2013)、维普数据库(VIP,1993-2013)和中国生物医学文献数据库光盘版(CBMdisc,1993-2013),按纳入、排除标准收集相关文献,对其进行资料提取和方法学质量评价,使用Revman 5.2软件对资料进行Meta分析。结果:共纳入13个随机对照研究,均为中文文献,方法学质量不高。Meta分析显示:药师开展的药学干预对糖尿病患者的用药依从性[RR=1.83,95%CI(1.32,2.53),P=0.000 2]、空腹血糖[SMD=-2.82,95%CI(-4.49,-1.14),P=0.001]、糖化血红蛋白[SMD=-1.58,95%CI(-2.58,-0.57),P=0.002]的影响有统计学意义。对餐后2小时血糖[SMD=-3.12,95%CI(-6.69,0.45),P=0.09]、药品不良事件发生率[RR=0.45,95%CI(0.17,1.14),P=0.09]的影响无统计学意义。结论:药师开展的药学干预能提高糖尿病患者的用药依从性,改善血糖控制。但仍需要开展大规模设计良好的随机对照研究和更长时间的随访来进一步验证。

Objective： To evaluate the effect of pharmacist intervention on the medication compliance and blood glucose control of patients with diabetes in China. Methods： A computer-based retrieval was conducted of Pubmed（ 1993- 2013）, CNKI（ 1993- 2013）, VIP（ 1993- 2013） and CBMdisc（ 1993- 2013） for collecting the relevant data according to predefined inclusion and exclusion criteria and then studies were identified and their quality was evaluated. The meta-analysis was performed using Revman 5.2 software. Results： Thirteen randomized controlled trials（RCTs） were included which were published in Chinese. The results of meta-analysis showed there were significant differences between pharmacist intervention group and control group in the medication compliance of patients with diabetes mellitus [RR = 1.83,95% CI（1.32,2.53）, P = 0. 000 2 ], FPG [ SMD =- 2. 82, 95 % CI（-4.49,-1.14）, P = 0.001], and Hb A1 c [SMD =-1.58,95% CI（-2.58,-0.57）, P = 0.002]. There were no significant differences in 2h PG [SMD =-3.12,95% CI（-6.69,0.45）, P = 0.09] and incidence rate of adverse events [RR = 0.45,95% CI（0.17,1.14）, P = 0.09]. Conclusion： Pharmacist intervention can improve the medication adherence and blood glucose control of the patients with diabetes. However, it is still necessary to carry out well-designed large scale RCTs and longer follow-up studies for the further confirmation.