依从性治疗对精神疾病患者服药依从性及临床效果的系统评价

Effects of Adherence Therapy on Improving Medication Adherence and Clinical Outcomes in Patients with Psychosis:A Systematic Review

目的系统评价依从性治疗对精神疾病患者服药依从性和临床结局的影响。方法计算机检索The Cochrane Library(2015年10期)、PubMed、CBM、EMbase、VIP、EBSCO、CNKI和WanFang Data数据库,搜集依从性治疗对精神疾病患者用药效果影响的相关随机对照试验(RCT)。检索时限均从建库至2015年10月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.2软件进行Meta分析。结果共纳入13个RCT,1 268例患者。Meta分析结果显示:依从性治疗能够提高患者的服药态度依从性[MD=3.12,95%CI(1.26,4.98),P=0.001]和行为依从性[SMD=0.54,95%CI(0.21,0.88),P=0.001],提高功能[SMD=0.42,95%CI(0.28,0.56),P=0.000 01]和疾病自知力[SMD=0.34,95%CI(0.15,0.54),P=0.000 7]。但在缓解精神症状、减少住院时间、减少药物副反应和医疗消费的影响上,依从性治疗与其他治疗相当(P均>0.05)。结论依从性治疗能有效提高精神疾病患者的服药依从性,其间接效应包括提高功能和疾病自知力。受纳入研究数量和质量的限制,上述结论尚需开展更多高质量研究予以验证。

Objective To systematically review the effects of adherence therapy in improving medication adherence and clinical outcomes in psychosis patients.Methods We searched databases including PubMed,EMbase,The Cochrane Library（Issue 10,2015）,EBSCO,CBM,CNKI,VIP,and WanFang Data from inception to Oct.2015,to collect randomized controlled trials（RCTs） about adherence therapy for patients with psychosis.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies.Then,meta-analysis was performed using RevMan 5.2 software.Results A total of 13 RCTs involving 1 244 patients were included.The results of metaanalysis showed that adherence therapy could improve attitude towards medication adherence（MD=3.12,95%CI 1.26 to4.98,P=0.001）,behavioral adherence（SMD=0.54,95%CI 0.21 to 0.88,P=0.001）,function（SMD=0.42,95%CI 0.28 to 0.56,P=0.000 01） and insight of diseases（SMD=0.34,95%CI 0.15 to 0.54,P=0.000 7） in patients with psychosis.But regarding psychotic symptoms,hospital stay,medical costs and adverse drug reactions,adherence therapy did not show benefit（all P values 〉0.05）.Conclusion Current evidence shows that adherence therapy could improve medication adherence,function and insight towards diseases in patients with psychosis.Due to the limited quantity and quality of included studies,more large-scale,multi-center,and high quality RCTs are needed to verify the above conclusion.