電子製薬包装装置と薬物投与の遵守:体系的なレビュー
Kyle D Checchi1, Krista F Huybrechts1, Jerry Avorn1
1Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
JAMA
|September 24, 2014
まとめ
電子医薬品パッケージング (EMP) デバイスは,慢性疾患の薬剤耐用性を改善する可能性があります. 投与イベントを記録するヘルスケアに統合されたシステムは,最も有望であることが示されましたが,より高品質な研究が必要です.
科学分野:
- 医療情報工学 医療情報工学
- 薬剤耐用性研究 薬剤耐用性研究
- デジタル・ヘルス・インターベンション デジタル・ヘルス・インターベンション
背景:
- 薬物不服従は,高血圧,高脂血症,糖尿病などの慢性疾患を有する患者の有意な部分に影響します.
- 服従を監視するために設計された電子医薬品パッケージング (EMP) デバイスは,患者の服従を改善するための潜在的な解決策を提供します.
研究 の 目的:
- 薬の服従を改善するEMPデバイスの有効性を評価する.
- 既存のEMPデバイスの共通の特徴を特定し,特徴づけること.
主な方法:
- 4326人の患者が参加した37件のピアレビュー研究 (32件のランダム化,5件の非ランダム化) の体系的レビューが行われました.
- 研究は複数のデータベース (MEDLINE,EMBASE,PsycINFO,CINAHLなど) から採取された. 2014年6月までです.
- バイアスの評価はコクランハンドブックを使用し,EMPデバイスの特徴を質的に分析した.
主要な成果:
- アデレンスに対する介入の影響は様々で,平均アデレンス差は -2.9% から +34.0% まで,アデレンス比率は -8.0% から +49.5% までだった.
- EMPの共通の特徴には,記録された投与イベント,オーディオビジュアルリマインダー,デジタルディスプレイ,リアルタイムモニタリング,およびアダプションフィードバックが含まれます.
- 医療システムに統合された複雑な介入と投与イベントの記録は,服従の改善と最も関連していました.
結論:
- 様々なEMPデバイスが利用可能ですが,支持する証拠は限られており,研究の質も異なります.
- 医療の提供に統合され,投与イベントを記録するデバイスは,改善された遵守と最も一貫した関連性を示しています.
- EMPデバイスの有効性を確認し,薬剤不服症に対するそのコンポーネントを最適化するために,さらに高品質な研究が必要である.
関連する概念動画
01:23Modified-Release Drug Delivery Systems: Classification
306
Modified-release drug delivery systems improve drug efficacy and minimize side effects by controlling the rate and location of drug release. These systems fall into three categories: rate-programmed, stimuli-activated, and site-targeted.Rate-programmed systems release drugs at a predetermined rate, maintaining consistent therapeutic levels and reducing fluctuations that could lead to toxicity or subtherapeutic effects. These systems use polymeric matrices, reservoir-based designs, or osmotic...
306
01:19Modified-Release Drug Delivery Systems: Overview
228
Modified-release dosage forms are designed to address the limitations of drugs with short biological half-lives. These forms maintain stable therapeutic drug concentrations over extended periods, reducing the need for frequent dosing. A consistent drug level helps minimize peak-trough fluctuations, which can reduce adverse effects, lower the risk of drug resistance, and improve overall treatment effectiveness.One common type of modified-release form is the extended-release (ER) formulation. ER...
228
01:26Oral Drug Delivery Systems: Continuous-Release Systems
288
Continuous-release drug delivery systems offer a strategic approach to maintaining therapeutic drug levels over extended periods following oral administration. By modulating the release rate of active pharmaceutical ingredients, these systems minimize fluctuations in plasma concentrations, which enhances clinical efficacy and reduces the need for frequent dosing. Such characteristics make them particularly advantageous in managing chronic diseases where patient adherence and stable drug...
288
01:19Modified-Release Drug Delivery Systems: Rate-Programmed II
128
Rate-programmed drug delivery systems release drugs in a controlled manner to maintain therapeutic levels. Three main designs include reservoir, matrix, and hybrid systems.Reservoir systems consist of a drug core enclosed within a membrane that controls drug release. In non-swelling reservoir systems, polymers like ethyl cellulose or polymethacrylates are used. These do not hydrate in aqueous media and control release through membrane thickness, porosity, or insolubility. This type includes...
128
01:28Dosage Regimens: Designs and Approaches
594
Designing a dosage regimen, which refers to the manner of drug administration, is a complex process involving the selection of drug dose, route, and frequency. This process is underpinned by pharmacokinetic parameters derived from tests and population averages. These parameters are then tailored to patient-specific variables such as diagnosis, demographics, and allergy status. Once therapy commences, therapeutic response monitoring is critical and achieved through clinical and physical...
594
01:30Modified-Release Drug Delivery Systems: Stimuli-Activated
168
Stimuli-activated drug delivery systems are designed to release drugs in response to specific physical, chemical, or biological stimuli. These systems often utilize hydrogels—three-dimensional, hydrophilic polymer networks capable of swelling in aqueous environments and retaining significant fluid volumes. Upon exposure to particular stimuli, these hydrogels undergo structural transitions that allow the embedded drug to be released. Due to this adaptive behavior, such systems are also...
168