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首页> 外文期刊>Addictive behaviors >Temporal patterns of adherence to medications and behavioral treatment and their relationship to patient characteristics and treatment response
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Temporal patterns of adherence to medications and behavioral treatment and their relationship to patient characteristics and treatment response

机译：依从药物和行为治疗的时间模式及其与患者特征和治疗反应的关系

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Background: The primary analyses of the COMBINE Study revealed significant naltrexone and Combined Behavioral Intervention (CBI) main effects on drinking outcomes but failed to find additional benefits of the combination of treatments. Investigating differences in patterns of adherence over time may shed light on the treatment effects in COMBINE. The goals of the study were to identify trajectories of medication adherence and participation in CBI, to estimate predictive and moderating effects of adherence trajectories on drinking outcomes and to characterize subjects in adherence trajectories. The results of these analyses may suggest approaches to improving adherence in order to ultimately improve treatment outcome. Methods: We used a trajectory-based approach to identify patterns of treatment adherence separately for naltrexone, acamprosate and CBI adherence. Logistic regression and general linear models assessed associations among adherence trajectories, drinking outcomes and patient characteristics. Results: Three trajectories of adherence were identified for each treatment: "excellent adherers", "late non-adherers" and "early non-adherers" and there was good agreement among adherence trajectories with different treatments. "Excellent adherers" had significantly higher percent days abstinent (PDA) and lower percent heavy drinking days (PHDD). CBI significantly decreased PHDD for subjects on acamprosate in the "early non-adherers with medication" trajectory (p = 0.01). Either naltrexone or acamprosate was associated with lower PHDD than placebo for "early non-adherers with CBI" (p. <0.01). Receiving active medication decreased the likelihood to be in the excellent medication adherence trajectory. Younger age, greater drinking severity, dissatisfaction with the medicine and session frequency, adverse events and lack of benefit were related to less favorable medication adherence trajectories. "Excellent adherers with CBI" were significantly more satisfied with the CBI counselor. Conclusions: Patterns of treatment adherence appear to be a participant characteristic. Individuals who fail to adhere early in treatment have worse outcomes regardless of treatment. However, treatment outcomes of participants who exhibit early problems with adherence to one treatment modality could potentially be improved by offering an alternative behavioral or pharmacologic treatment.
机译：背景：COMBINE研究的初步分析显示，纳曲酮和联合行为干预（CBI）对饮酒结局有重大影响，但未能找到联合治疗的其他益处。研究随时间变化的依从性差异可能有助于阐明COMBINE的治疗效果。该研究的目的是确定药物依从性和参与CBI的轨迹，评估依从轨迹对饮酒结果的预测和调节作用，并表征依从轨迹的受试者。这些分析的结果可能会提出改善依从性的方法，以最终改善治疗效果。方法：我们采用基于轨迹的方法分别确定纳曲酮，阿坎酸和CBI依从性的治疗依从性模式。 Logistic回归和一般线性模型评估了依从性轨迹，饮酒结果和患者特征之间的关联。结果：每种治疗方法均确定了三种依从性轨迹：“优秀依从性”，“晚期非依从性”和“早期非依从性”，并且不同治疗的依从性轨迹之间具有良好的一致性。 “优秀的依从者”的禁酒日百分比（PDA）和重度饮酒日百分比（PHDD）明显较低。 CBI显着降低了“早期非粘附用药者”治疗中阿坎酸的受试者的PHDD（p = 0.01）。对于“ CBI早期非粘附者”，纳曲酮或阿坎酸与PHDD均低于安慰剂（p。<0.01）。接受有效药物治疗降低了药物依从性良好的可能性。年龄较小，饮酒严重程度较高，对药物和疗程的不满意程度，不良事件和获益不足与药物依从性差有关。 CBI的顾问对“优秀的CBI拥护者”感到更加满意。结论：治疗依从性模式似乎是参与者的特征。未能坚持早期治疗的个体无论治疗如何都会有较差的预后。但是，通过提供替代的行为或药物治疗方法，可能会改善那些因坚持一种治疗方式而出现早期问题的参与者的治疗效果。

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