以簡化藥物治療方式改善門診高血壓病患服藥遵從成效探討：系統性文獻回顧

Simplified Medication in Improving Adherence among Ambulatory Patients with Hypertension: A Systematic Review

10.6168/FJCP.2013.2104.05

何振珮(Chen-Pei Ho)；李哲夫(Tony Jer-Fu Lee)

簡化藥物治療 ； 高血壓 ； 服藥遵從 ； Simple Medication ； Hypertension ； Adherence

臺灣臨床藥學雜誌

21卷4期（2013 / 12 / 31）

321 - 333

繁體中文

血壓無法控制在理想範圍主要原因之一為服藥遵從不佳。本研究目的為回顧簡化藥物治療對於改善高血壓病患服藥遵從成效。以系統性回顧簡化藥物治療改善門診高血壓病患服藥遵從文獻，資料庫搜尋至2011年4月，搜尋CENTRAL、MEDLINE、EMBASE、CINAHL、臺灣期刊論文索引系統、中國期刊全文資料庫及中文思博網。研究篩選出十六篇隨機控制實驗文獻，文獻研究年代介於1981至2009年，研究地區為歐洲、美國、加拿大，研究人數介於23至7,274人，介入時間為三週至八個月。結果發現簡化服藥品項與顆數介入研究有三篇文獻，只有一篇文獻對於改善服藥遵從呈顯著差異，兩組服藥遵從相差7.8%。簡化服藥頻率介入研究有十三篇文獻，有九篇文獻對於改善服藥遵從呈顯著差異，兩組服藥遵從相差1 ~ 13%。文獻回顧發現簡化服藥品項與顆數，對於改善服藥遵從並沒有顯著介入成效，而簡化服藥頻率對於改善服藥遵從卻有顯著介入成效。因此改善高血壓病患服藥遵從介入方式，並不能只進行簡化藥物治療，應進行混合介入方式，才能有效持續改善病患服藥遵從與血壓控制。

Poor adherence to antihypertensive medications is a major reason for inadequate control of hypertension. The purpose of this communication is to review the effectiveness of simple medication in improving adherence among hypertensive patients. The information is obtained mainly from the following sources: CENTRAL, MEDLINE, EMBASE, CINAHL, Index to Taiwan Periodical Literature System, China Journal Full-text Database and Chinese Electronic Periodical Services for all-language publications in April 2011, all studies included sixteen randomized controlled trials in 1981 to 2009, and 23 to 7,274 hypertensive outpatients in Europe, United States of America and Canada with follow-up duration of 3 weeks to 8 months. The results indicate that significant difference in adherence with regard to simplifying medication types and pill count occurs in 1 of 3 studies, with a relative increase in adherence by 7.8%. Significant difference also exists by simplifying dosage frequency in 9 of 13 studies, with a relative increase in adherence by 1 to 13%. The conclusion is that simplification of dosage frequency significantly increases adherence. On the other hand, no significant effect on adherence is found by simplifying medication types and pill count. Although simplified medication alone appears to be effective in improving adherence in hypertensive patients, complex interventions should be included to achieve continuation in improving adherence.

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