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Maßnahmen, um die Therapietreue bei Tabakabhängigkeit zu steigern

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Appendices

Appendix 1. Taxonomy of possible interventions (adapted from Haynes 2008)

a) more instruction for patients, e.g. verbal, written, or visual material; programmed learning; and formal education sessions;

b) counselling about the patients’ target condition, the importance of therapy and compliance with therapy, the possible side‐effects, patient empowerment, couple‐focused therapy to increase social support;

c) automated telephone, computer‐assisted patient monitoring and counselling;

d) manual telephone follow‐up;

e) family intervention;

f ) various ways to increase the convenience of care, e.g. provision at the worksite or at home;

g) simplified dosing;

h) involving patients more in their care through self‐monitoring;

i) reminders, e.g. programmed devices, and tailoring the regimen to daily habits;

j) special ’reminder’ medication packaging;

k) dose‐dispensing units of medication and medication charts;

l) appointment and prescription refill reminders;

m) reinforcement or rewards for both improved adherence and treatment response, e.g. reduced frequency of visits;

n) different medication formulations, such as tablet versus syrup ;

o) crisis intervention conducted when necessary;

p) direct observation of treatments (DOTS) by health workers or family members;

q) lay health mentoring;

r) augmented pharmacy services;

s) psychological therapy, e.g. cognitive behaviour therapy, multisystemic therapy;

t) mailed communications;

u) group meetings.

Appendix 2. MEDLINE (Ovid SP) search strategy

 

1              exp medication adherence/   7730

2              exp smoking cessation/  20345

3              (adhere* or complian* or concord*).tw.   222406             

4              or/1‐3   244332 

5              (NRT or nicotine replacement therap* or bupropion or wellbutrin or zyban or voxra or budeprion or aplenzin or amfebutamone or varenicline or chantix or champix).tw.   5254

6              (nicotine adj7 (patch* or gum* or inhaler* or inhalator* or lozenge* or microtab* or tablet* or spray*)).tw.   2247                               

7              5 or 6   6925        

8              randomised controlled trial.pt.   379042

9              controlled clinical trial.pt.   88839              

10           clinical trial.pt.   489753 

11           random*.tw.   656627   

12           placebo.tw.   151719      

13           trial.tw.   341515              

14           groups.tw.   1279987     

15           or/8‐14   2179105             

16           4 and 7 and 15   1705      

17           limit 16 to humans   1700

 

Appendix 3. Embase (Ovid SP) search strategy

1              exp medication adherence/   4398        

2              exp smoking cessation/   37433 

3              (adhere* or complian* or concord*).tw.   310641             

4              or/1‐3   348019 

5              (NRT or nicotine replacement therap* or bupropion or wellbutrin or zyban or voxra or budeprion or aplenzin or amfebutamone or varenicline or chantix or champix).tw.   8998                

6              (nicotine adj7 (patch* or gum* or inhaler* or inhalator* or lozenge* or microtab* or tablet* or spray*)).tw.   2677                               

7              5 or 6   10951        

8              randomised controlled trial/   345939     

9              single blind procedure/ or double blind procedure/   131682       

10           crossover procedure/   39531                    

11           random*.tw.   884924   

12           placebo*.tw.   199266   

13           ((singl* or doubl*) adj (blind* or mask*)).tw.   157668   

14           (cross over or crossover or factorial* or latin square).tw.   93570               

15           (assign* or allocat* or volunteer*).tw.   488528 

16           or/8‐15   1411900             

17           4 and 7 and 16   1897      

18           limit 17 to human   1836

Appendix 4. PsycINFO (Ovid SP) search strategy

1              exp medical regimen compliance/   11128

2              exp smoking cessation/   9156   

3              (adhere* or complian* or concord*).tw.   46968               

4              or/1‐3   58112    

5              (NRT or nicotine replacement therap* or bupropion or wellbutrin or zyban or voxra or budeprion or aplenzin or amfebutamone or varenicline or chantix or champix).tw.   2854

6              (nicotine adj7 (patch* or gum* or inhaler* or inhalator* or lozenge* or microtab* or tablet* or spray*)).tw.   1221               

7              5 or 6   3739        

8              random*.ti,ab,hw,id.   132134   

9              trial*.ti,ab,hw,id.   123964

10           placebo*.ti,ab,hw,id.   31234     

11           ((singl* or doubl* or trebl* or tripl*) and (blind* or mask*)).ti,ab,hw,id.   22030

12           (cross over or crossover or factorial* or latin square).ti,ab,hw,id.   21908               

13           (assign* or allocat* or volunteer*).ti,ab,hw,id.   119014   

14           treatment effectiveness evaluation/   16887     

15           mental health program evaluation/   1870            

16           exp experimental design/   47784            

17           "2000".md.   27392          

18           or/8‐17   379651               

19           4 and 7 and 18   1030        

20           limit 19 to human   1016

Appendix 5. Cochrane Central Register of Controlled Trials (CENTRAL) search strategy

#1           (adhere* or complian* or concord*):ti,ab,kw   24410

#2           (NRT or nicotine replacement therap* or bupropion or wellbutrin or zyban or voxra or budeprion or aplenzin or amfebutamone or varenicline or chantix or champix):ti,ab,kw or (nicotine adj7 (patch* or gum* or inhaler* or inhalator* or lozenge* or microtab* or tablet* or spray*)):ti,ab,kw   1589       

#3           (#1 AND #2) in Trials   147

Study flow diagram
Figuras y tablas -
Figure 1

Study flow diagram

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Primary outcome (adherence), Outcome 1 Adherence ‐ Dichotomous outcomes.
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Analysis 1.1

Comparison 1 Primary outcome (adherence), Outcome 1 Adherence ‐ Dichotomous outcomes.

Comparison 1 Primary outcome (adherence), Outcome 2 Adherence ‐ Continuous outcomes.
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Analysis 1.2

Comparison 1 Primary outcome (adherence), Outcome 2 Adherence ‐ Continuous outcomes.

Comparison 2 Secondary outcomes, Outcome 1 Short‐term abstinence < 6 months.
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Analysis 2.1

Comparison 2 Secondary outcomes, Outcome 1 Short‐term abstinence < 6 months.

Comparison 2 Secondary outcomes, Outcome 2 Long‐term abstinence ≥ 6 months.
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Analysis 2.2

Comparison 2 Secondary outcomes, Outcome 2 Long‐term abstinence ≥ 6 months.

Summary of findings for the main comparison. Interventions to increase adherence compared to standard care for improving adherence to medications for tobacco dependence and abstinence from smoking

Interventions to increase adherence compared to standard care for improving adherence to medications for tobacco dependence and abstinence from smoking

Patient or population: Adult smokers
Settings: Typically in‐person clinical settings
Intervention: Interventions to increase adherence through providing information and facilitating problem‐solving
Comparison: Standard care

Outcomes

Relative effect (95% CI)

Illustrative comparative risks (95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Standard care

Interventions to increase adherence

Adherence to medications for tobacco dependence (dichotomous outcomes)

RR 1.14
(1.02 to 1.28)

Study population

1630
(5 RCTs)

⊕⊕⊕⊝
MODERATE 1

368 per 1000 achieve a specified satisfactory level of adherence

419 per 1000 (375 to 471) achieve a specified satisfactory level of adherence

Adherence to medications for tobacco dependence (continuous outcomes)

SMD 0.07

(‐0.03 to 0.17)

The mean level of adherence is 0

The mean level of adherence is 0.07 standard deviations higher (0.03 lower to 0.17 higher)

1529
(4 RCTs)

⊕⊕⊝⊝
LOW 1,2

Short‐term abstinence from smoking (<6 months)

RR 1.07
(0.95 to 1.21)

Study population

1755
(4 RCTs)

⊕⊕⊝⊝
LOW 1,3

363 per 1000 achieve abstinence

389 per 1000 (345 to 439) achieve abstinence

Long‐term abstinence from smoking (≥6 months)

RR 1.16
(1.01 to 1.34)

Study population

3049
(4 RCTs)

⊕⊕⊝⊝
LOW 1,4

171 per 1000 achieve abstinence

198 per 1000 (173 to 229) achieve abstinence

The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1All studies are judged to be at high or unclear risk of bias which lowers confidence in estimate of effect

2Includes sufficient sample size for single adequately powered trial but 95% CI overlaps no effect and ranges from very small harm to small benefit

3Includes sufficient sample size for single adequately powered trial but 95% CI overlaps no effect and ranges from small harm to substantial benefit

4Substantial heterogeneity with inconsistency in point estimates and limited overlap of confidence intervals

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Summary of findings for the main comparison. Interventions to increase adherence compared to standard care for improving adherence to medications for tobacco dependence and abstinence from smoking
Table 1. Brief descriptions of adherence interventions

Study

Brief description of specific intervention components intended to increase adherence*

Additional contact time relative to standard care?

Medication for which adherence was targeted

Chan

2010

Added counselling contact time to standard behavioural support, focusing specifically on medication adherence

Yes

NRT

Chan

2011

Added counselling contact time to standard behavioural support, focusing specifically on medication adherence

Yes

NRT

Marteau

2012

Tailored and communicated about NRT dosage using a more potent rationale (genotype versus phenotype)

No

NRT

Mooney

2005

Personalised feedback of questionnaire responses regarding medication

No

NRT

Mooney

2007

Personalised feedback of externally validated medication adherence

Yes

Bupropion

Nollen

2011

Added counselling contact time to standard behavioural support, focusing specifically on medication adherence

Yes

Varenicline

Schmitz

2005

Personalised feedback of externally validated medication adherence

Yes

Bupropion

Smith

2013

Added counselling contact time to standard behavioural support, focusing specifically on medication adherence

Yes

NRT

* For further details see Characteristics of Included Studies

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Table 1. Brief descriptions of adherence interventions
Comparison 1. Primary outcome (adherence)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Adherence ‐ Dichotomous outcomes Show forest plot

5

1630

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [1.02, 1.28]

2 Adherence ‐ Continuous outcomes Show forest plot

4

1529

Std. Mean Difference (IV, Fixed, 95% CI)

0.07 [‐0.03, 0.17]

Figuras y tablas -
Comparison 1. Primary outcome (adherence)
Comparison 2. Secondary outcomes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Short‐term abstinence < 6 months Show forest plot

4

1755

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.95, 1.21]

2 Long‐term abstinence ≥ 6 months Show forest plot

4

3049

Risk Ratio (M‐H, Fixed, 95% CI)

1.16 [1.01, 1.34]

Figuras y tablas -
Comparison 2. Secondary outcomes