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文献分享 |Educational programmes for improving medication adherence among older adults with coronary artery disease: A systematic review and meta-analysis
来源：International Journal of Nursing Studies
DOI：10.1016/j.ijnurstu.2024.104924
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Abstract
Background: Coronary artery disease is the leading cause of death worldwide. Adhering to coronary artery disease medications is the priority of its treatment. Medication adherence is suboptimal among older adults with coronary artery disease. Educational programmes are used and recommended in improving medication adherence among older adults with coronary artery disease. The evidence about the effects of educational programmes on medication adherence among older adults with coronary artery disease is, however, limited.
背景:冠心病是导致全球死亡的主要原因。坚持服用冠心病药物是治疗冠心病的首要任务。患有冠心病的老年人的服药依从性并不理想。为改善患有冠状动脉疾病的老年人的服药依从性，人们使用并推荐教育计划。然而，有关教育计划对患有冠状动脉疾病的老年人坚持服药的影响的证据却很有限。
Aim: To evaluate the effects of educational programmes designed for improving medication adherence among older adults with coronary artery disease.目标:评估旨在改善患有冠状动脉疾病的老年人服药依从性的教育计划的效果。Methods: 12 English databases and five Chinese databases were searched from database inception to January 2024. Randomised controlled trials examining the effects of educational programmes for improving medication adherence among older adults (aged 60 years old or above) with coronary artery disease (including myocardial infarction,stable or unstable angina,undergoing percutaneous coronary intervention,or undergoing coronary artery bypass grafting) were included. The quality of the included studies was assessed by the Cochrane Risk of Bias Tool v2. Meta-analysis was conducted using random-effect models with Review Manager 5.3. Narrative synthesis was conducted if the results of the included studies were not appropriate or possible for meta-analysis. The Grading of Recommendations,Assessment, Development,and Evaluation approach was used to assess the certainty of evidence.方法：检索了从数据库建立到 2024 年 1 月的 12 个英文数据库和 5 个中文数据库。纳入的随机对照试验研究了改善患有冠状动脉疾病（包括心肌梗死、稳定型或不稳定型心绞痛、接受经皮冠状动脉介入治疗或接受冠状动脉旁路移植术）的老年人（60 岁或以上）服药依从性的教育计划的效果。纳入研究的质量由 Cochrane 偏倚风险工具 v2 进行评估。使用Review Manager 5.3的随机效应模型进行meta分析。如果纳入研究的结果不适合或不可能进行meta分析，则进行叙述性综合。采用 "建议、评估、发展和评价分级法 "评估证据的确定性。Results: 5607 records were retrieved, and 5600 records were excluded. Six randomised controlled trials were included. The results showed that educational programmes could significantly improve medication adherence at two to six months post-intervention (standardised mean difference (SMD): 1.13, 95 % confidence interval (CI): 0.33 to 1.94, P = 0.006, Moderate certainty of evidence),but there was no significant evidence to support their effect on medication adherence within one-month post-intervention (SMD: 2.18, 95 % CI: − 1.22, 5.58, P = 0.21, Low certainty of evidence). Narrative synthesis found that the educational programmes potentially improved medication adherence over six months post-intervention, understanding of coronary artery disease and related medications,and medication management capacity.结果：共检索到 5607 条记录，排除了 5600 条记录。其中包括六项随机对照试验。结果显示，教育项目可显著提高干预后两到六个月内的用药依从性（标准化平均差（SMD）：1.13，95% 置信区间（CI）：0.33 至 1.94，P = 0.006，中度证据确定性），但没有显著证据支持其对干预后一个月内的用药依从性的影响（SMD：2.18，95% 置信区间（CI）：- 1.22 至 5.58，P = 0.21，低度证据确定性）。叙述性综述发现，教育计划有可能改善干预后六个月内的用药依从性、对冠心病及相关药物的了解以及用药管理能力。Conclusion:Educational programmes could significantly improve medication adherence among older adults with coronary artery disease at two to six months post-intervention,and potentially improve medication adherence over six months post-intervention. The effect on medication adherence within one-month post-intervention was inconclusive. Designing the educational programmes with theoretical frameworks and refined components helps address their complex health needs. More rigorous evaluation of the effects of educational programmes on medication adherence of the older adults with coronary artery disease is warranted.结论：在干预后的两到六个月内，教育计划可明显改善患有冠心病的老年人的服药依从性，并有可能改善干预后六个月内的服药依从性。干预后一个月内对服药依从性的影响尚无定论。设计具有理论框架和精炼内容的教育计划有助于满足他们复杂的健康需求。有必要对教育计划对患有冠心病的老年人坚持服药的效果进行更严格的评估。Keywords:Coronary artery disease;Medication adherenc;eEducational programme;Older adults;Systematic review;Meta-analysis
关键词：冠心病；药物依从性；教育计划；老年人群；系统回顾；Meta分析
（译文仅供参考）
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