Anforderungen an Adherence/Persistence-Programme am Beispiel von oralen Antidiabetika bei Diabetes Typ 2-Patienten: Ein systematisches Review (Artikel)
|Anforderungen an Adherence/Persistence-Programme am Beispiel von oralen Antidiabetika bei Diabetes Typ 2-Patienten: Ein systematisches Review (Artikel)|
|Autor||Thomas Wilke, Sabrina Müller, Antje Groth, Ulf Maywald, Frank Verheyen|
|In:||Gesundheitsökonomie & Qualitätsmanagement|
Aim: The aim of this review is 1. to give an overview about the extent of medication-based nonadherence (NA)/nonpersistence (NP) related to oral antidiabetics (OAD) in Diabetes mellitus type II (DM 2) therapy and 2. to evaluate the effectiveness of adherence interventions (AI) aimed to reduce NA/NP in OAD therapy in relation to their methodological quality. Method: A systematic review of DM 2 studies regarding the extent of NA/NP concerning OAD and of AI effectiveness studies was conducted (Medline/NML and Embase). Only interventions aiming to improve medication adherence/persistence were included. All AI were evaluated regarding their methodological quality and their effectiveness (2 outcomes: adherence/persistence and clinical outcomes). Results: All in all, 62 studies evaluating the NA/NP extent in OAD and 15 publications evaluating 19 different AI were included in this review. According to the study mean, NA affects 29.1 % to 39.2 % and NP affects 56.1 % of the DM 2 patients; naturally, extent of NA/NP depends both on its definition and used NA/NP measures. Four dimensions of the methodological quality of AI were identified: 1. measurement of adherence/persistence/clinical outcomes, 2. measurement of NA/NP causes, 3. use of effective/validated intervention measures, 4. effective program evaluation. The authors defined 5 detailed methodological requirements per dimension and, based on this, developed a corresponding scoring model (MIN Score 0, MAX score 20). All 19 AI programs were evaluated in the scoring model (average score 8.05): Score < 5: 3 AI – no AI (0 %) with adherence/persistence/blood glucose level improvement; Score 5 – 9: 8 AI – 6 AI (75 %) with improvement in adherence/persistence/blood glucose levels; Score > 9: 8 AI – all AI (100 %) improved adherence and/or blood glucose levels. Conclusion: In future, AI will play a much more important part than nowadays in the German health care system. However, the existing evidence concerning their limited effectiveness shows that a lot of research is needed in order to understand factors explain a program’s effectiveness. The scoring model provides first implications for the methodical evaluation of AI.