The impact of non-pharmacological interventions on adherence to medication and persistence in dyslipidaemia and hypertension: a systematic review

Suboptimal medication adherence is common among patients with cardiovascular diseases. We sought evidence on non-pharmacological interventions used to support adherence for patients with hypertension and/or dyslipidemia. We searched MEDLINE, EMBASE, MEDLINE In-Process, ClinicalTrials.gov, EUCTR, and conference proceedings from July 2011 to July 2021 to identify trials evaluating effects of health education, phone reminders, or digital interventions on medication adherence or persistence of adult patients with hypertension and/or dyslipidemia. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool v2. Of 64 studies, 62 used health education approaches (e.g. educational interviews, motivational meetings, advice from physicians, and mobile health content), 16 phone reminders (e.g. text reminders, electronic pill-box linked reminders, bi-directional text messaging), and 10 digital applications as interventions (e.g., various self-management applications). All studies assessed medication adherence; only two persistence. Overall, 30 studies (83%) assessing health education approaches alone and 25 (78%) combined with other strategies, 12 (75%) phone reminders and eight studies (80%) digital applications combined with other strategies reported improved medication adherence. Two studies assessing health education approaches reported improved persistence. Our findings indicate non-pharmacological interventions may positively impact adherence. Therefore, ‘beyond the pill’ approaches could play a role in preventing cardiovascular diseases.

心血管疾病患者的服药依从性（medication adherence）是较为普遍的现象。本研究旨在检索用于辅助高血压和/或血脂异常患者改善服药依从性的非药物干预措施相关证据。我们于2011年7月至2021年7月期间，检索了医学文献检索数据库（MEDLINE）、荷兰医学文摘数据库（EMBASE）、MEDLINE In-Process、临床试验注册平台（ClinicalTrials.gov）、欧盟临床试验注册中心（EUCTR）以及会议论文集，以筛选评估健康教育、电话提醒或数字干预措施对高血压和/或血脂异常成年患者服药依从性及服药持续性（medication persistence）影响的临床试验。采用Cochrane偏倚风险评估工具第2版（Cochrane Risk of Bias Assessment Tool v2）对研究的偏倚风险进行评估。纳入分析的64项研究中，62项采用了健康教育类干预措施（如教育访谈、激励性会面、医师指导及移动健康内容），16项采用电话提醒类干预措施（如短信提醒、电子药盒联动提醒、双向短信），另有10项以数字应用程序作为干预手段（如各类自我管理应用程序）。所有研究均对服药依从性进行了评估，仅2项研究评估了服药持续性。整体而言，仅采用健康教育类干预措施的30项研究（占比83%）、联合其他干预策略的25项研究（占比78%）、采用电话提醒类干预措施的12项研究（占比75%），以及联合其他策略的8项数字应用类干预研究（占比80%）均报告了服药依从性的改善情况。另有2项采用健康教育类干预措施的研究报告了服药持续性的提升。本研究结果表明，非药物干预措施可对服药依从性产生积极影响。因此，‘非药物’干预策略可为心血管疾病的预防发挥积极作用。