50 Years Ago in TheJournal ofPediatrics: Why Patients Don't Follow Medical Advice: A Study of Children on Long-Term Antistreptococcal Prophylaxis.
50 Years Ago in TheJournal ofPediatrics: Why Patients Don't Follow Medical Advice: A Study of Children on Long-Term Antistreptococcal Prophylaxis.
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50 年前，《儿科杂志》：为什么患者不遵循医疗建议：一项针对儿童长期抗链球菌预防的研究。
DOI：
10.1016/j.jpeds.2019.05.047
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Ross,LainieFriedman
中科院分区：
文献类型：
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作者：
Sobotka,SarahA;Ross,LainieFriedman
Gordis等人描述了一项对有风湿热病史的儿童的队列研究，与学校护士合作，每周随机安排尿液标本，以确定推荐的口服青霉素预防依从性。为了确定不遵守规定的风险因素，作者检查了111名非裔美国儿童的队列，并提供了完整的数据。调查了人口统计学和医学因素、风湿热和青霉素知识、家庭结构、文化和态度因素的相关性。青少年和女童的依从性较低，而因风湿性心脏病住院和任何年龄的父母参与（如陪同孩子去诊所）与治疗依从性增加有关。重要的是，这与父母的收入、教育程度、职业或生活在单亲家庭无关。作者建议针对有多种风险因素的患者加强随访。今天，急性风湿热和风湿性心脏病在发达国家很少见，但在发展中地区仍然很高。1在高患病率地区进行的研究已经确定，缺乏获得医疗保健的机会（例如，缺乏保险覆盖或距离卫生设施很远）是导致依从性差的原因，2,3值得注意的是，Gordis等人没有研究这些因素。此外，在新喀里多尼亚进行的一项基于人群的调查中，建议包括个人层面的干预措施（例如，加强患者教育）和系统层面的解决方案（例如，任命一名护士来协调登记系统）。2这种对影响个人健康的系统级干预措施的现代关注突出了过去50年来对健康的社会和体制决定因素重要性的不断发展的理解。
Gordis et al describe a cohort study of children with a history of rheumatic fever who, in collaboration with school nurses, were followed with weekly randomly scheduled urine specimens to determine compliance with recommended oral penicillin prophylaxis. To identify risk factors for noncompliance, the authors examined a cohort of 111 African American children with complete data. Correlations with demographic and medical factors, rheumatic fever and penicillin knowledge, family structure, and cultural and attitudinal factors were examined. Adolescents and female children were found to be less compliant, whereas hospitalization for rheumatic heart disease and parental involvement at any age (as indicated by accompanying their child to the clinic) were associated with increased treatment adherence. Importantly, there was no correlation with parental income, education, or occupation, or living in a single parent home. The authors recommended intensive followup efforts be directed at patients with multiple risk factors for noncompliance.Today, acute rheumatic fever and rheumatic heart disease are rare in the developed world but remain high in developing regions. 1 Studies in areas of high prevalence have determined that lack of access to medical care (eg, lack of insurance coverage or long distance to health facilities) contribute to poor adherence, 2, 3 factors notably not studied by Gordis et al. In addition, in a population-based investigation conducted in New Caledonia, recommendations included both individual-level interventions (eg, increasing patient education), and systemlevel solutions (eg, an appointed nurse to coordinate a registry system). 2 This modern focus on system-level interventions to influence individual health highlights the evolving understanding of the importance of social and institutional determinants of health over the last 5 decades.