改善成年高血压患者服药依从性干预措施的最佳证据总结

Summary of the Best Evidence for Interventions to Improve Medication Adherence in Adults with Hypertension

目的检索和总结改善成年高血压患者服药依从性干预措施的最佳证据。方法依据复旦大学循证护理中心的循证问题PIPOST体系确立工具构建循证问题,按照“6S”证据模型从上到下的原则,计算机检索在BMJ Best Practice、澳大利亚乔安娜布里格斯研究所(JBI)循证卫生保健中心、加拿大安大略注册护士协会网(RNAO)、苏格兰学院间指南网络(SIGN)、国际高血压学会、日本高血压学会、美国心脏协会(AHA)、欧洲心脏病学会(ESC)、法国高血压学会(FSAH)、Cochrane Library、UpToDate、PubMed、Web of Science、卫生保健及护理学数据库(CINAHL)、Embase、医脉通、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普网上公开发表的关于改善成年高血压患者服药依从性的文献,检索时限为建库至2022-01-10。由3名经过循证护理学课程培训的硕士研究生组成研究小组并进行文献质量评价、文献筛选及内容提取,并进行最佳证据总结,同时评价证据质量及划分推荐级别。结果本研究最终共纳入20篇文献,包括9篇系统评价、6篇指南、3篇专家共识、1篇临床决策、1篇证据总结。6篇指南中,2篇为A级推荐、4篇为B级推荐。9篇系统评价的质量评价总分均≥9分。3篇专家共识的质量评价总分均>5分。1篇临床决策提取的证据来自2篇系统评价(与本研究纳入的文献重合)、1篇类实验研究(质量评价总分为8.5分)、2篇队列研究(质量评价总分均为9.0分)。1篇证据总结的证据来自1篇系统评价(质量评价总分为10.5分)。对纳入的文献进行证据提取,最终形成了改善成年高血压患者服药依从性干预措施的最佳证据总结,其包括卫生系统层面(5条证据)、健康教育和随访(4条证据)、治疗方案选择(3条证据)、自我管理(5条证据)4个维度共17条证据。结论本研究总结的改善成年高血压患者服药依从性干预措施的最佳证据包括卫生系统层面、健康教育和随访、治疗方案选择、自我管理4个维度共17条证据,可为医护人员改善成年高血压患者服药依从性提供借鉴及参考。

Objective To retrieve and summarize the best evidence for interventions to improve medication adherence in adults with hypertension.Methods Evidence-based problems were constructed in accordance with the evidence-based problem PIPOST system establishment tool of the Evidence-based Nursing Center of Fudan University.Following the top-to-bottom principle of"6S"evidence model,online published literature on the improvement of medication adherence in adults with hypertension was searched by computer retrieval at the BMJ Best Practice,Joanna Briggs Institute(JBI)Centre for Evidence-Based Health Care in Australia,Canadian Registered Nurses'Association of Ontario(RNAO),Scottish Intercollegiate Guidelines Network(SIGN),the International Society of Hypertension,Japanese Society of Hypertension,American Heart Association(AHA),European Society of Cardiology(ESC),French Society of Arterial Hypertension(FSAH),Cochrane Library,UpToDate,PubMed,Web of Science,Cumulative Index to Nursing and Allied Health Literature(CINAHL),Embase,Medilve,China Biomedical Literature Database,CNKI,Wanfang Data and VIP,with the retrieval time limit from the establishment of the database to 2022-01-10.Three postgraduates trained in evidence-based nursing courses formed a research team and conducted literature quality evaluation,literature screening and content extraction,and summarized the best evidence.At the same time,the quality of evidence was evaluated and the level of recommendation was classified.Results A total of 20 literature was included in this study,including 9 systematic reviews,6 guidelines,3 expert consensus,1 clinical decision,and 1 evidence summary.Among the 6 guidelines,2 were grade A recommendations and 4 were grade B recommendations.The total score of the quality evaluation of the nine systematic reviews was≥9 points,while that of the three expert consensus was>5 points.One piece of evidence for clinical decision was extracted from 2 systematic reviews(overlapping with the literature included in this study),1 quasi-experment study(total quality assessment score was 8.5 points),2 cohort studies(both total quality assessment scores were 9.0 points).One piece of summarized evidence was gathered from 1 systematic review(total quality assessment score was 10.5 points).With the evidence extraction from the included literature,the best evidence summary of interventions to improve the medication adherence of adult patients with hypertension was collected,it included a total of 17 pieces of evidence from 4 dimensions including health system level(5 pieces of evidence),health education and follow-up(4 pieces of evidence),treatment options(3 pieces of evidence)and self-management(5 pieces of evidence).Conclusion The best evidence of interventions to improve medication adherence in adults with hypertension summarized in this study includes 17 pieces of evidence from four dimensions,including health system level,health education and follow-up,treatment options,and self-management,which can provide reference for medical staff to improve medication adherence in adult patients with hypertension.