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首页> 外文期刊>The journal of clinical psychiatry >Guideline Implementation and Patient-Tailoring Strategies to Improve Medication Adherence for Schizophrenia.
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Guideline Implementation and Patient-Tailoring Strategies to Improve Medication Adherence for Schizophrenia.

机译：改善精神分裂症药物依从性的指南实施和患者定制策略。

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OBJECTIVE: To determine the effectiveness of an intervention to promote medication adherence. METHOD: Data were collected for adults with exacerbation of schizophrenia who were treated at one of 6 U.S. Department of Veterans Affairs (VA) Medical Centers (VAMCs) in 3 regional VA networks (Veterans Integrated Service Networks [VISNs]) from March 1999 to October 2000. All 6 VAMCs received a basic guideline implementation strategy for medication management of schizophrenia using usual VA procedures. One VAMC within each VISN was randomly selected to receive an enhanced implementation strategy designed to promote guideline-concordant prescribing by physicians and medication adherence by patients. In the enhanced strategy, a research nurse worked with study participants to identify medication adherence barriers and to develop patient-specific strategies to overcome those barriers. Participants (N = 349) were interviewed at enrollment and 6 months later, using the Structured Clinical Interview for the Positive and Negative Syndrome Scale (PANSS), the Barnes Akathisia Rating Scale, and the Schizophrenia Outcomes Module (SCHIZOM). Medication adherence was measured via subjects' self-report, using the SCHIZOM, and from data abstracted from medical records. RESULTS: Participants were primarily male (94%) and nonwhite (69%, primarily African American) with a mean age of 46 years. Medication adherence at follow-up was modeled using logistic regression, controlling for adherence at baseline, demographic characteristics, PANSS total score, akathisia at baseline, family history of mental illness, and substance abuse. A logistic regression model for adherence at follow-up was significant (likelihood ratio = 52.72, df = 14, p < .0001). Patients enrolled at sites receiving the enhanced intervention were almost twice as likely to be adherent at follow-up. Those who were nonadherent at baseline were significantly less likely to be adherent at follow-up. In addition, adherence at follow-up was significantly greater at 2 of the VA networks as compared to the third network. CONCLUSIONS: These data suggest that a patient-centered strategy to identify and overcome barriers to adherence can improve adherence to antipsychotic medications.
机译：目的：确定促进药物依从性的干预措施的有效性。方法：收集1999年3月至10月在3个区域VA网络（退伍军人综合服务网络[VISNs]）中的6个美国退伍军人事务（VA）医疗中心（VAMC）之一接受治疗的精神分裂症加重成人的数据。 2000年。所有6个VAMC均接受了使用常规VA程序进行精神分裂症药物管理的基本准则实施策略。在每个VISN中随机选择一个VAMC，以接受增强的实施策略，该策略旨在促进医师遵照指南开处方和患者依从药物。在增强策略中，一名研究护士与研究参与者合作，确定药物依从性障碍并制定针对患者的针对性策略以克服这些障碍。参加者（N = 349）在入组时和6个月后使用阳性和阴性综合征量表（PANSS），Barnes Akathisia评分量表和精神分裂症结果模块（SCHIZOM）进行结构化访谈。药物依从性是通过使用SCHIZOM通过受试者的自我报告以及从病历中提取的数据来测量的。结果：参与者主要是男性（94％）和非白人（69％，主要是非裔美国人），平均年龄为46岁。随访时的药物依从性采用逻辑回归建模，控制基线时的依从性，人口统计学特征，PANSS总分，基线时的静坐不全，精神疾病的家族病史和药物滥用。随访时依从性的逻辑回归模型很显着（似然比= 52.72，df = 14，p <.0001）。接受加强干预的地点入组的患者在随访中几乎是其依从性的两倍。基线时不依从的患者在随访中依从的可能性大大降低。此外，与第三个网络相比，其中两个VA网络在随访时的依从性明显更高。结论：这些数据表明，以患者为中心的策略可以识别和克服依从性障碍，可以改善对抗精神病药物的依从性。

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