摘要
背景老年人多重用药现象已日益普遍。而多重用药依从性与其治疗效果及安全性密切相关,故早期了解老年人多重用药依从性及其影响因素具有重要意义。但目前研究结论差异较大,尚无明确统一的标准。目的系统评价老年人多重用药依从性现状及其影响因素,为后期提高老年人多重用药依从性,减少不良反应,进一步制订个性化干预方案提供参考。方法计算机检索PubMed、Embase、Web of Science、Cochrane Library、Scopus、Ovid、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、维普网中有关老年人多重用药(年龄≥60岁,用药种类≥5种)依从性影响因素的队列研究、病例对照研究、横断面研究等观察性研究,检索时限为建库至2023年3月。由2名研究者按照纳入与排除标准独立进行文献筛选、质量评价以及资料提取。采用Stata 17.0和RevMan 5.3软件进行Meta分析。结果共纳入19篇文献,总样本量为130047例,其中服药依从性好的人数为50852例。Meta分析结果显示,老年人多重用药的服药依从率为41%〔95%CI(34%,47%)〕,多重用药依从性与年龄〔OR=2.62,95%CI(1.60,4.78),P<0.0001〕、性别〔OR=1.70,95%CI(1.30,2.23),P=0.0001〕、文化程度〔OR=1.73,95%CI(1.38,2.16),P<0.00001〕、居住方式〔OR=2.85,95%CI(2.18,3.72),P<0.00001〕、用药知识水平〔OR=1.14,95%CI(1.04,1.25),P=0.005〕、服药信念〔OR=2.06,95%CI(1.44,2.93),P<0.0001〕、抑郁〔OR=2.52,95%CI(1.96,3.24),P<0.00001〕、日常生活能力(ADL)〔OR=2.39,95%CI(1.68,3.38),P<0.00001〕、跌倒史〔OR=3.51,95%CI(2.03,6.06),P<0.00001〕、专业人员指导〔OR=3.75,95%CI(1.92,7.33),P=0.0001〕、用药种类数量〔OR=2.58,95%CI(1.96,3.41),P<0.0001〕、药物不良反应〔OR=3.08,95%CI(2.17,4.38),P<0.0001〕、用药方案复杂性〔OR=1.08,95%CI(1.03,1.14),P=0.004〕、药物管理〔OR=1.92,95%CI(1.34,2.75),P=0.0003〕、用药费用〔OR=2.60,95%CI(1.30,5.17),P=0.0007〕有关。敏感性分析结果显示,Meta分析结果相对稳定。Begg's检验(P=0.441)和Egger's检测(P=0.674)提示纳入文献的发表偏倚风险较低。结论老年人多重用药依从率为41%。且现有证据表明:一般因素(年龄、性别、文化程度、居住方式),心理、社会因素(抑郁、ADL、跌倒史、用药知识水平、服药信念、专业人员指导),药物因素(药物管理、用药费用、用药方案复杂性、用药种类数量、药物不良反应)是老年人多重用药依从性的影响因素,医务人员应根据老年人多重用药依从性的影响因素,制订个性化的干预措施,优化多重用药老年人疾病管理。
Background Polypharmacy is increasingly common in the elderly.The medication compliance of polypharmacy is closely related to its therapeutic effect and safety.Therefore,it is of great significance to understand the medication compliance and its influencing factors in the elderly with polypharmacy at early stage.However,the conclusions of current studies vary greatly,and there is no clear and unified standard.Objective To systematically evaluate the current status of polypharmacy in the elderly and its influencing factors,in order to provide reference for improving medication compliance of polypharmacy in the elderly,reducing adverse reactions,and further developing individualized intervention programs.Methods PubMed,Embase,Web of Science,Cochrane Library,Scopus,Ovid,CBM,CNKI,Wanfang Data and VIP were searched for cohort studies,case-control studies,cross-sectional studies and other observational studies on the influencing factors of medication compliance of polypharmacy in the elderly from inception to March 2023.Two researchers independently screened the literature,evaluated the quality and extracted the data according to the inclusion and exclusion criteria.Stata 17.0 and RevMan 5.3 software were used for meta-analysis.Results A total of 19 studies were included with the total sample size of 130047 subjects,including 50852 subjects with good medication compliance.Meta-analysis results showed that the medication compliance rate of polypharmacy in the elderly was 41%〔95%CI(34%,47%)〕,which was associated with age〔OR=2.62,95%CI(1.60,4.78),P<0.0001〕,gender〔OR=1.70,95%CI(1.30,2.23),P=0.0001〕,education level〔OR=1.73,95%CI(1.38,2.16),P<0.00001〕,residential lifestyle〔OR=2.85,95%CI(2.18,3.72),P<0.00001〕,medication knowledge level〔OR=1.14,95%CI(1.04,1.25),P=0.005〕,medication belief〔OR=2.06,95%CI(1.44,2.93),P<0.0001〕,depression〔OR=2.52,95%CI(1.96,3.24),P<0.00001〕,daily living ability(ADL)〔OR=2.39,95%CI(1.68,3.38),P<0.00001〕,history of falls〔OR=3.51,95%CI(2.03,6.06),P<0.00001〕,professional guidance〔OR=3.75,95%CI(1.92,7.33),P=0.0001〕,the number of drug types〔OR=2.58,95%CI(1.96,3.41),P<0.0001〕,adverse drug reactions〔OR=3.08,95%CI(2.17,4.38),P<0.0001〕,medication regimen complexity〔OR=1.08,95%CI(1.03,1.14),P=0.004〕,medication management〔OR=1.92,95%CI(1.34,2.75),P=0.0003〕and medication cost〔OR=2.60,95%CI(1.30,5.17),P=0.0007〕.Sensitivity analysis showed that the results of meta-analysis were relatively stable.Begg's test(P=0.441)and Egger's test(P=0.674)suggested that there was a low risk of publication bias for medication compliance of polypharmacy in the elderly in the included studies.Conclusion The compliance rate of polypharmacy in the elderly is 41%.And the available evidence shows that general factors(age,gender,education level,residential lifestyle),psychological and social factors(depression,ADL,history of falls,medication knowledge level,medication belief,professional guidance),drug factors(medication management,medication cost,medication regimen complexity,the number of drug types,adverse drug reactions)are the influencing factors of medication compliance of polypharmacy in the elderly.Medical staff should formulate individualized intervention measures and optimize disease management in the elderly with polypharmacy according to the influencing factors of medication compliance of polypharmacy.
作者
谢雪梅
高静
柏丁兮
卢贤英
何佳丽
李月
XIE Xuemei;GAO Jing;BAI Dingxi;LU Xianying;HE Jiali;LI Yue(School of Nursing,Chengdu University of Traditional Chinese Medicine,Chengdu 611137,China)
出处
《中国全科医学》
北大核心
2023年第35期4394-4403,共10页
Chinese General Practice
基金
四川省社科规划项目(SC22B150)。
